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Airflow Limitation in Smokers Is Associated with Subclinical Atherosclerosis

¹ Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan; ² Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Kochi, Japan; and ³ Nippon Telegraph and Telephone West Corporation, Chugoku Health Administration Center, Hiroshima, Japan

Correspondence and requests for reprints should be addressed to Akihito Yokoyama, M.D., Ph.D., Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505, Japan. E-mail: ayokoyama{at}kochi-u.ac.jp

Rationale: Chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality from cardiovascular disease. Although a close association between COPD and atherosclerosis has been speculated, such scientific information is limited.

Objectives: To evaluate subclinical atherosclerosis in smokers with airflow limitation.

Methods: The subjects of this study were healthy middle-aged men. Smokers with airflow limitation (n = 61) and age-matched control smokers (n = 122) and control never-smokers (n = 122) without airflow limitation were included in the present study. Subjects with diabetes, acute infection, and respiratory disease other than COPD were excluded beforehand. All subjects underwent chest radiogram, spirometry, blood sampling, and carotid ultrasonography. We determined carotid intima-media thickness and focal atheromatous plaque as indicators of subclinical atherosclerosis.

Measurements and Main Results: Mean carotid intima-media thickness was greater in smokers with airflow limitation than in control smokers (P < 0.01) and control never-smokers (P < 0.005). Focal carotid plaque was significantly more prevalent in smokers with airflow limitation than in control never-smokers (P < 0.005). Multivariate analyses showed significant associations between thickened intima-media thickness and decreased percent predicted FEV₁ (P = 0.001) and between plaque and log₁₀ C-reactive protein (P = 0.013) independent of age, pack-years of smoking, body mass index, peripheral mean arterial pressure, heart rate, glucose, and low-density lipoprotein cholesterol.

Conclusions: Smokers with airflow limitation had exaggerated subclinical atherosclerosis. This study suggests that middle-aged men who are susceptible to COPD may also be susceptible to vascular atherosclerosis by smoking, and atherosclerotic change starts early in the disease process of COPD.

Key Words: chronic obstructive pulmonary disease • systemic inflammation • airflow obstruction • intima-media thickness • carotid plaque

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Chronic obstructive pulmonary disease (COPD) is associated with increased morbidity and mortality from cardiovascular disease. Although a close association between COPD and atherosclerosis has been speculated, such scientific information is limited. What This Study Adds to the Field Smokers with airflow limitations have exaggerated atherosclerosis, which indicates that atherosclerotic change starts early in the disease process of COPD.

 

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