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Published ahead of print on March 15, 2007, doi:10.1164/rccm.200701-067OC

Am. J. Respir. Crit. Care Med., Volume 175, Number 12, June 2007, 1259-1265

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Submitted on January 13, 2007
Accepted on March 15, 2007

Arterial Stiffness and Osteoporosis in Chronic Obstructive Pulmonary Disease

Ramsey Sabit1, Charlotte E Bolton1, Peter H Edwards2, Rebecca J Pettit3, William D Evans3, Carmel M McEniery4, Ian B Wilkinson4, John R Cockcroft5, and Dennis J Shale1*

1 Department of Respiratory Medicine, Cardiff University, Academic Centre, Llandough Hospital, Penarth, Vale of Glamorgan, United Kingdom, 2 Ely Bridge Surgery, Cardiff, Vale of Glamorgan, United Kingdom, 3 Department of Medical Physics and Clinical Engineering, University Hospital of Wales, Cardiff, Vale of Glamorgan, United Kingdom, 4 Department of Clinical Pharamcology, University of Cambridge, Addenbrooke's Hospital, Cambridge, Middlesex, United Kingdom, 5 Department of Cardiology, Cardiff University, Wales Heart Research Institute, University Hospital of Wales, Cardiff, Vale of Glamorgan, United Kingdom

* To whom correspondence should be addressed. E-mail: shaledj{at}cardiff.ac.uk.

Rationale: Chronic Obstructive Pulmonary Disease (COPD) is associated with an increased risk of cardiovascular events and osteoporosis. Increased arterial stiffness is an independent predictor of cardiovascular disease. Objectives: We tested the hypothesis that patients with COPD would have increased arterial stiffness which would be associated with osteoporosis and systemic inflammation. Methods: We studied 75 clinically stable patients with a range of severity of airways obstruction and 42 healthy smoker or ex-smoker controls, free of cardiovascular disease. All subjects underwent spirometry, measurement of aortic pulse wave velocity (PWV) and augmentation index, dual-energy X-ray absorptiometry and blood sampling for inflammatory mediators. Main Results: Mean (SD) aortic PWV was greater in patients, 11.4 (2.7) m/s, than controls, 8.95 (1.7) m/s, p<0.0001. Inflammatory mediators and augmentation index were also greater in patients. Patients with osteoporosis at the hip had a greater aortic PWV, 13.1 (1.8) m/s than those without, 11.2 (2.7) m/s, p<0.05. In patients, aortic PWV was related to age (r=0.63, p<0.0001), log10 interleukin-6 (IL-6) (r=0.31, p<0.01) and inversely to FEV1 (r=-0.34, p<0.01). The strongest predictors of aortic PWV in all subjects were age (p<0.0001), % predicted FEV1 (p<0.05), mean arterial pressure (p<0.05) and log10 IL-6 (p<0.05). Conclusions: Increased arterial stiffness was related to the severity of airflow obstruction and may be a factor in the excess risk for cardiovascular disease in COPD. The increased aortic PWV in patients with osteoporosis and the association with systemic inflammation suggests age related bone and vascular changes occur prematurely in COPD.
Key words: COPD, cardiovascular disease, arterial stiffness, osteoporosis, systemic inflammation




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