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Determinants of Systemic Vascular Function in Patients with Stable Chronic Obstructive Pulmonary Disease

¹ St. Anna Childrens Hospital, Vienna, Austria; ² Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute for COPD, Otto Wagner Hospital, Vienna, Austria; and ³ Department of Medicine, Wilhelminen Hospital, Vienna, Austria

Correspondence and requests for reprints should be addressed to Otto Chris Burghuber, M.D., F.C.C.P., Department of Respiratory and Critical Care Medicine, Otto-Wagner-Hospital Sanatoriumstrasse 2, 1140 Wien, Vienna, Austria. E-mail: otto.burghuber{at}wienkav.at

Rationale: Impaired vascular reactivity is an important factor in the pathogenesis of cardiovascular disease.

Objectives: We sought to assess vascular reactivity in patients with chronic obstructive pulmonary disease (COPD) and respective control subjects, and to investigate the relation between vascular function and airflow obstruction and systemic inflammation.

Methods: We studied 60 patients with stable COPD; 20 smokers with normal lung function matched for age, sex, and body weight; and 20 similarly matched nonsmokers. Patients with cardiovascular comorbidities were excluded. The endothelium-dependent and endothelium-independent function of the vasculature was measured using flow-mediated and nitrogen-mediated dilation of the brachial artery, respectively. Systemic inflammatory markers, including C-reactive protein, fibrinogen, and interleukin (IL)-6, were determined in serum.

Measurements and Main Results: Both flow-mediated and nitrogen-mediated dilation of the brachial artery were significantly lower in patients with stable COPD than in smoking and nonsmoking control subjects. Levels of inflammatory mediators such as IL-6 and fibrinogen were higher in patients than they were in control subjects. In patients with COPD, stepwise multiple regression analysis showed that age, sex, baseline brachial artery diameter, C-reactive protein level, leukocyte count, blood glucose level, and percentage of predicted forced expiratory volume in 1 s were independent predictors of flow-mediated dilation. There was no relation between flow-mediated dilation and pack-years of smoking. Baseline brachial artery diameter was the only independent predictor of nitrogen-mediated dilation in patients with COPD.

Conclusions: Both endothelium-dependent and endothelium-independent vasodilation is significantly impaired in patients with stable COPD. Airflow obstruction and systemic inflammation may increase the risk of cardiovascular disease in patients with COPD.

Key Words: systemic vascular function • chronic obstructive pulmonary disease • cardiovascular disease • systemic inflammation

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Patients with chronic obstructive pulmonary disease (COPD) are at an increased risk of cardiovascular disease. The mechanism for this relationship, however, remains unknown. What This Study Adds to the Field Impaired flow-mediated dilation was strongly related to systemic inflammation and airway obstruction, which may help explain the increased cardiovascular morbidity in patients with COPD.

 

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