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Published ahead of print on October 3, 2008, doi:10.1164/rccm.200709-1412OC

Am. J. Respir. Crit. Care Med., Volume 178, Number 12, December 2008, 1211-1218

A more recent version of this article appeared on December 15, 2008
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Submitted on September 22, 2007
Accepted on October 3, 2008

Determinants of Systemic Vascular Function in Patients with Stable COPD

Philipp Eickhoff1, Arschang Valipour2, Dora Kiss2, Martin Schreder3, Leyla Cekici2, Kora Geyer2, Robab Kohansal2, and Otto C Burghuber2*

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, 3 1. Department of Medicine, Wilhelminen Hospital, Vienna, Austria

* To whom correspondence should be addressed. E-mail: otto.burghuber{at}wienkav.at.

Rationale and Objectives: Impaired vascular reactivity is an important factor in the pathogenesis of cardiovascular disease. We sought to assess vascular reactivity in patients with COPD and respective controls, and to investigate the relation between function with 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-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 controls. Levels of inflammatory mediators such as interleukin-6 and fibrinogen were higher in patients than they were in controls. 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 second 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




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