Published ahead of print on October 17, 2008, doi:10.1164/rccm.200804-560OC Am. J. Respir. Crit. Care Med., Volume 179, Number 1, January 2009, 35-40 A more recent version of this article appeared on January 1, 2009
Submitted on April 15, 2008 Airflow Limitation in Smokers is Associated with Subclinical AtherosclerosisHiroshi Iwamoto1,1 Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan; Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan, 2 Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan, 3 Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan, 4 Chugoku Health Administration Center, Nippon Telegraph and Telephone West Corporation, Hiroshima, Hiroshima, Japan * To whom correspondence should be addressed. 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. Objective: 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. Results: Mean carotid intima-media thickness in smokers with airflow limitation was greater 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 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. Conclusion: 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
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