Insulin resistance may contribute to vascular dysfunction in patients with chronic obstructive pulmonary disease

Urban, Matthias; Ay, Leyla; Funk, Georg‐Christian; Burghuber, Otto Chris; Eickhoff, Philipp; Wolzt, Michael; Valipour, Arschang

doi:10.1007/s00508-013-0478-0

Cited by 11 publications

(15 citation statements)

References 30 publications

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“…Seventeen original studies used ultrasound-based FMD to determine endothelial function in patients with COPD ( Figure 1, Table 1 and 2) [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. A total number of 1228 participants was evaluated: 724 patients with a spirometry-based diagnosis of COPD (71% men; mean age: 65±5 years; body mass index (BMI): 27±2 kg/m 2 ) and 504 controls (56% men; mean age: 62±8 years; BMI: 27±2 kg/m 2 ) ( Table 1).…”

Section: Resultsmentioning

confidence: 99%

Endothelial function in patients with chronic obstructive pulmonary disease: a systematic review of studies using flow mediated dilatation

Vaes

Spruit

Theunis

et al. 2017

Expert Review of Respiratory Medicine

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This review provides evidence for impaired peripheral endothelial function in COPD. Since impaired endothelial function may contribute to cardiovascular morbidity, a more comprehensive cardiovascular phenotyping is considered important in COPD to address cardiovascular risk. A high frequency of cardiovascular comorbidity is observed in COPD patients, and therefore well-controlled, larger studies that investigate endothelial function in COPD patients are recommended.

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Section: Resultsmentioning

confidence: 99%

Endothelial function in patients with chronic obstructive pulmonary disease: a systematic review of studies using flow mediated dilatation

Vaes

Spruit

Theunis

et al. 2017

Expert Review of Respiratory Medicine

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show abstract

“…During this time FMD decreased and fasting blood glucose increased. FMD was significantly negatively correlated with fasting blood glucose suggesting that patients with worse glucose control also had worse endothelial function [129]. Interestingly, other studies have demonstrated that uncontrolled diabetes mellitus is also associated with worse lung function in COPD patients.…”

Section: Introductionmentioning

confidence: 99%

“…Rho-kinase inhibitors have also improved NO release from endothelial cells in vitro suggesting that blocking this pathway may provide another means to improve endothelial dysfunction [137]. As FMD is associated with poor glucose control screening COPD patients for fasting blood glucose and controlling abnormal glucose levels might provide another method of improving endothelial function in these patients [129]. …”

Section: Introductionmentioning

confidence: 99%

The role of the endothelium in asthma and chronic obstructive pulmonary disease (COPD)

Green

Turner

2017

Respir Res

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COPD and asthma are important chronic inflammatory disorders with a high associated morbidity. Much research has concentrated on the role of inflammatory cells, such as the neutrophil, in these diseases, but relatively little focus has been given to the endothelial tissue, through which inflammatory cells must transmigrate to reach the lung parenchyma and cause damage. There is evidence that there is an abnormal amount of endothelial tissue in COPD and asthma and that this tissue and its’ progenitor cells behave in a dysfunctional manner. This article reviews the evidence of the involvement of pulmonary endothelium in COPD and asthma and potential treatment options for this.

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“…Insulin stimulates mitochondrial protein synthesis, which is crucial for maintaining mitochondrial functional activity . Insulin resistance causes endothelial dysfunction and impaired vasodilation . This can slow the increase in microvascular blood flow in skeletal muscle in response to moderate exercise, contributing to exercise limitation .…”

Section: Discussionmentioning

confidence: 99%

“…18 Insulin resistance causes endothelial dysfunction and impaired vasodilation. 19 This can slow the increase in microvascular blood flow in skeletal muscle in response to moderate exercise, contributing to exercise limitation. 20 Early onset of peripheral neuropathy in people with insulin resistance could also contribute to skeletal muscle impairment.…”

Section: Significance Of the Findingsmentioning

confidence: 99%

Insulin resistance is associated with skeletal muscle weakness in COPD

2015

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Background and objective: Quadriceps weakness is seen across all GOLD stages of COPD and is associated with increased morbidity and mortality. As quadriceps weakness is only weakly associated with FEV1, mechanisms other than airflow obstruction are implicated. We tested the hypothesis that insulin resistance contributes to skeletal muscle weakness in people with stable COPD. Methods: Fifty-one COPD patients (no exacerbations preceding 6 weeks, no rehabilitation preceding 3 months) without known diabetes mellitus underwent assessment of skeletal muscle, including measurement of quadriceps maximal voluntary contraction (QMVC). Physical activity was measured for 7 days using a multisensory biaxial accelerometer armband. Insulin resistance (HOMA2 IR) was calculated from fasting blood glucose and insulin concentrations. Results: QMVC was 30 ± 13 kg (74 ± 25% predicted) and 16 (31%) participants had quadriceps weakness. There was a negative univariate correlation between HOMA2 IR and QMVC (r = −0.446, P = 0.002). HOMA2 IR was greater in people with quadriceps weakness (1.59 ± 0.99) than in those without (1.11 ± 0.55, P = 0.032). On multivariate analysis, with age, sex, weight, BODE index and step count per day included in the model, a one-unit increase in insulin resistance was associated with a 5.9 (2.0-9.8)-kg decrease in QMVC (P = 0.004) and a 4.2 (1.3-14.3)-fold increased risk of quadriceps weakness (P = 0.02). Conclusion: Insulin resistance is associated with skeletal muscle weakness in COPD, independent of potential confounders. Further studies are required to explore underlying mechanisms and determine whether insulin-sensitizing drugs could augment pulmonary rehabilitation in building skeletal muscle strength in COPD.

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Insulin resistance may contribute to vascular dysfunction in patients with chronic obstructive pulmonary disease

Abstract: Altered glucose metabolism may be associated with progression of endothelial dysfunction in patients with COPD.

Cited by 11 publications

References 30 publications

Endothelial function in patients with chronic obstructive pulmonary disease: a systematic review of studies using flow mediated dilatation

Endothelial function in patients with chronic obstructive pulmonary disease: a systematic review of studies using flow mediated dilatation

The role of the endothelium in asthma and chronic obstructive pulmonary disease (COPD)

Insulin resistance is associated with skeletal muscle weakness in COPD

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