Does pulmonary rehabilitation address cardiovascular risk factors in patients with COPD?

Abstract

BackgroundPatients with COPD have an increased risk of cardiovascular disease. Whilst pulmonary rehabilitation has proven benefit for exercise tolerance and quality of life, any effect on cardiovascular risk has not been fully investigated. We hypothesised that pulmonary rehabilitation, through the exercise and nutritional intervention, would address these factors.MethodsThirty-two stable patients with COPD commenced rehabilitation, and were compared with 20 age and gender matched controls at baseline assessment. In all subjects, aortic pulse wave velocity (PWV) an independent non-invasive predictor of cardiovascular risk, blood pressure (BP), interleukin-6 (IL-6) and fasting glucose and lipids were determined. These measures, and the incremental shuttle walk test (ISWT) were repeated in the patients who completed pulmonary rehabilitation.ResultsOn commencement of rehabilitation aortic PWV was increased in patients compared with controls (p < 0.05), despite mean BP, age and gender being similar. The IL-6 was also increased (p < 0.05). Twenty-two patients completed study assessments. In these subjects, rehabilitation reduced mean (SD) aortic PWV (9.8 (3.0) to 9.3 (2.7) m/s (p < 0.05)), and systolic and diastolic BP by 10 mmHg and 5 mmHg respectively (p < 0.01). Total cholesterol and ISWT also improved (p < 0.05). On linear regression analysis, the reduction in aortic PWV was attributed to reducing the BP.ConclusionCardiovascular risk factors including blood pressure and thereby aortic stiffness were improved following a course of standard multidisciplinary pulmonary rehabilitation in patients with COPD.

Extrapulmonary comorbidities in chronic obstructive pulmonary disease: state of the art

“…It is not clear that any one class or regimen of antihypertensives is favorable in COPD, therefore it should be managed in accordance with local policies and guidance. Pulmonary rehabilitation has also recently been shown to reduce blood pressure [54].…”

Pulmonary rehabilitation and cardiovascular risk in COPD: a systematic review

“…Of the three included studies, two investigated COPD patients who had been enrolled on a PR programme, and one reported outcomes from patients enrolled on an exercise endurance training programme. In summary, with regard to the effect of PR on CV risk in COPD, we found one larger negative study [7] and two smaller positive studies [5,6].…”

“…In the Gale study [6], arterial stiffness significantly improved after PR. Additionally, there was a significant reduction in central mean arterial pressure (103 ± 14 to 95 ± 14 mmHg; p = <0.001) which may account for the reduction in aPWV.…”

“…Additionally, there was a significant reduction in central mean arterial pressure (103 ± 14 to 95 ± 14 mmHg; p = <0.001) which may account for the reduction in aPWV. The larger negative study by Vanfleteren [7] was well designed consisting of 40 sessions, twice as many as Gale [6]. There was no effect on reduction of aPWV or on mean arterial pressure.…”

“…Arterial stiffness is a gold-standard predictor of individual cardiovascular risk [4], and a biomarker of elevated cardiovascular risk in COPD patients [5], as it is in healthy populations. It can be measured using aortic pulse wave velocity [6]. It is known that COPD patients have increased arterial stiffness compared to controls [7,8], and we have previously reported a relationship between the frequency of exacerbation and arterial stiffness [9].…”