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Published ahead of print on September 20, 2007, doi:10.1164/rccm.200707-1080OC
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American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 1208-1214, (2007)
© 2007 American Thoracic Society
doi: 10.1164/rccm.200707-1080OC

Original Article

Arterial Stiffness Is Independently Associated with Emphysema Severity in Patients with Chronic Obstructive Pulmonary Disease

David A. McAllister1, John D. Maclay1, Nicholas L. Mills2, Grant Mair1, Joy Miller1, David Anderson1, David E. Newby2, John T. Murchison3 and William MacNee1

1 ELEGI/Colt Laboratories, MRC Centre for Inflammation Research; 2 Centre for Cardiovascular Science; and 3 Department of Radiology, University of Edinburgh, Edinburgh, United Kingdom

Correspondence and requests for reprints should be addressed to David A. McAllister, M.B. Ch.B., Room SU305, The Chancellor's Building, 49 Little France Crescent, University of Edinburgh, Edinburgh, EH164SB UK. E-mail: david.mcallister{at}ed.ac.uk

Rationale: More patients with chronic obstructive pulmonary disease (COPD) die of cardiovascular causes than of respiratory causes, and patients with COPD have increased morbidity and mortality from stroke and coronary heart disease. Arterial stiffness independently predicts cardiovascular risk, is associated with atheromatous plaque burden, and is increased in patients with COPD compared with control subjects matched for cardiovascular risk factors. Elastin fragmentation and changes in collagen are found in the connective tissue of both emphysematous lungs and stiff arteries, but it is not known whether the severity of arterial stiffness in patients with COPD is associated with the severity of emphysema.

Objectives: To identify whether the extent of arterial stiffness is associated with emphysema severity.

Methods: We performed a cross-sectional study in 157 patients with COPD.

Measurements and Main Results: We measured pulse wave velocity (a validated measure of arterial stiffness), blood pressure, smoking pack-years, glucose, cholesterol, and C-reactive protein in 157 patients with COPD. We assessed emphysema using quantitative computed tomography scanning in a subgroup of 73 patients. We found that emphysema severity was associated with arterial stiffness (r = 0.471, P < 0.001). The association was independent of smoking, age, sex, FEV1% predicted, highly sensitive C-reactive protein and glucose concentrations, cholesterol–high-density lipoprotein ratio, and pulse oximetry oxygen saturations.

Conclusions: Emphysema severity is associated with arterial stiffness in patients with COPD. Similar pathophysiological processes may be involved in both lung and arterial tissue and further studies are now required to identify the mechanism underlying this newly described association.

Key Words: humans • elasticity • cardiovascular diseases • pulmonary emphysema


AT A GLANCE COMMENTARY

Scientific Knowledge on the Subject
Arterial stiffness, a marker of cardiovascular risk, is increased in patients with chronic obstructive pulmonary disease compared with matched control subjects and is associated with FEV1% predicted in healthy men. The mechanism is unknown but systemic inflammation in chronic obstructive pulmonary disease has been implicated.

What This Study Adds to the Field
Emphysema severity is associated with arterial stiffness in patients with COPD. This association is independent of airflow limitation and systemic inflammation.

 

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