S124 The BODE Index is an independent determinant of arterial stiffness in Chronic Obstructive Pulmonary Disease (COPD): Abstract S124 Table 1

Abstract

IntroductionCOPD is associated with increased cardiovascular events, independent of established risk factors. Arterial stiffness and carotid intima-media thickness (CIMT) are surrogates of cardiovascular risk and we sought to determine their relationship with COPD severity and prognosis in the ERICA (Evaluation of role of inflammation in airways disease) multi-site UK study: the largest cohort study focusing on cardiovascular manifestations in COPD.MethodsSpirometry, haemodynamic measures (aortic pulse wave velocity (aPWV), augmentation index (AIx), peripheral and central blood pressure (BP)) and CIMT (ultrasound measure of carotid artery intima-media layer thickness) were performed in 729 COPD subjects aged ≥40 years. COPD severity was classified by BODE Index [BMI, Obstruction (FEV1), Dyspnoea (mMRC score), Exercise tolerance (6-minute walk distance)], a validated score based on clinical variables and predictor of mortality in COPD.ResultsMean aPWV was 10.3 (SD 2.6) m/s, AIx 27 (10)%, brachial BP 144/82 (18/11) mmHg, central BP 131/82 (18/11) mmHg, CIMT 0.86 (0.4) mm.BODE correlated with aPWV (p < 0.0001) and this was maintained when adjusted for study site, age, supine heart rate (HR) mean arterial pressure (MAP), years smoked and cardiovascular comorbidities (MI, stroke, diabetes, peripheral vascular disease), p < 0.0001. BODE was also associated with AIx when adjusted for site, age, seated HR and MAP, years smoked and cardiovascular comorbidities, p < 0.01. The constituent variables of BODE did not have the same significant association with both aPWV and AIx, Table 1.Abstract S124 Table 1Comparison of linear regression models of BODE constituent variables, cardiovascular comorbidities and established predictors of arterial stiffnessDependent variableaPWV (m/s)Augmentation Index (%)β coefficientp-valueβ coefficientp-valueAge (years)0.4 <0.0001-0.010.7MAP (mmHg)*0.2 <0.00010.26 <0.0001HR (bpm)*0.2 <0.0001-0.49 <0.0001TPYs-0.0010.980.020.63BMI (kg/m2)0.090.01-0.17 <0.0001FEV1 (%)-0.060.090.050.14mMRC (0–4)0.070.090.0030.946MWD (m)-0.030.5-0.010.002MI-0.010.7-0.080.02Stroke-0.010.7-0.020.46Diabetes0.070.03-0.080.02PVD0.10.0040.010.78Study site-0.060.09-0.030.45*Supine for aortic pulse wave velocity (aPWV), seated for Augmentation Index.TPYs: Total pack years smoked, mMRC dyspnoea scale, 6MWD: 6-minute walk distance, MI: Myocardial Infarction, PVD: Peripheral Vascular Disease.Cardiovascular comorbidities: self-reported on questionnaire.An inverse correlation of BODE with central systolic BP (p = 0.003) was observed and this was maintained after adjustment for study site, age and HR p = 0.03. There was no significant relationship between BODE and CIMT.ConclusionsBODE is associated with arterial stiffness in COPD, independent of traditional risk factors. Its negative relationship with systolic pressure suggests increasing arterial stiffness with COPD severity, is independent of blood pressure. The BODE Index composite variables are not on the causal pathway for vascular stiffness, so its positive association likely ...

Review of the British Thoracic Society Winter Meeting 2015, 2–4 December, London, UK

“…Data from a large primary care cohort were used to identify patients with COPD at risk of hospital admission or death,52 which may help to find patients who need additional care. Cardiovascular risk in COPD was also a common theme in several sessions,53–55 including looking at arterial stiffness 56 57. One pragmatic study, comparing venous and arterial blood gas analysis, and now in press in Thorax , could potentially change our management of COPD exacerbations and improve patient experience 58…”