Aortic stiffness and microalbuminuria in patients with chronic obstructive pulmonary disease

Study the association of chronic obstructive pulmonary disease with early endothelial dysfunction and its impact on cardiovascular system by estimating urinary albumin creatinine ratio

Background:

Chronic obstructive pulmonary disease (COPD) attribute to systemic inflammation which is responsible for microalbuminuria reflecting endothelial dysfunction, could be a significant surrogate marker of potential cardiovascular morbidity.

Objective:

The aim of our study was to find out the possible association of COPD with early cardiovascular changes in the form of renal endothelial dysfunction.

Settings and Design:

Case–control, multi-group, cross-sectional hospital-based study was designed and conducted in the Department of Respiratory Medicine of BPS Government Medical College for Women, Khanpur Kalan, Sonipat, Haryana.

Subjects and Methods:

The study included 150 subjects, comprising of three groups with each having 50 subjects: Group 1 – acute exacerbation of COPD, Group 2 – stable COPD patients, Group 3 – asymptomatic smokers. Pulmonary function test, urine albumin creatinine ratio (UACR) and brachio-ankle pulse wave velocity were measured in all the subjects.

Statistical Analysis:

Data were analyzed using SPSS ver 20 (IBM, USA) software. Continuous variables were compared by unpaired Student's t-test while correlation was measured by Pearson correlation test, P < 0.05 was considered statistically significant.

Results:

The mean urine albumin creatinine ratio UACR value in acute exacerbation of COPD (283.30 mg/g; standard deviation [SD] ±871.98) was found significantly higher compare to control subjects (24.17 mg/g; SD ± 32.105;) P = 0.038. Besides this COPD patients with Type 2 respiratory failure having robust positive correlation in between UACR and arterial blood pH (r = 0.559; P = 0.030) while it was inverse and moderate with partial pressure of arterial oxygen (r = −0.470; P = 0.077).

Conclusions:

Acute state of COPD with or without Type 2 respiratory failure is having a significant impact on cardiovascular system in the form of early microvascular changes.

Subclinical atherosclerosis risk markers in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis

BACKGROUND AND AIMS

Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality. Identifying early changes of cardiovascular system before the occurrence of fatal clinical event is critical for the management of COPD. We performed a meta-analysis to investigate the associations between COPD and subclinical markers of cardiovascular risk.

METHODS

We searched PUBMED, EMBASE for studies published before Aug 1st, 2016, on the association between COPD and carotid intima-media thickness (CIMT), prevalence of carotid plaques, flow-mediated dilation (FMD), pulse-wave velocity (PWV) and augmentation index (AIx).

RESULTS

Thirty-two studies (3198 patients, 13867 controls) were included. Compared with controls, COPD patients had significantly higher CIMT (MD: 0.10 mm; 95% CI: 0.04, 0.16; p = 0.0007), PWV (SMD: 0.70; 95% CI: 0.52, 0.88; p < 0.0001), AIx (MD: 4.60%; 95% CI: 0.52, 8.68; p = 0.03), AIx@75 (AIx normalized to a heart rate of 75 beats per minute) (MD: 4.59%; 95% CI: 2.80, 6.38; p < 0.0001), prevalence of carotid plaque (OR: 2.54; 95% CI: 2.04, 3.15; p < 0.0001), and significantly lower FMD (MD: -4.21%; 95% CI: -6.71, -1.71; p = 0.001). Sensitivity and subgroups analyses substantially confirmed our results. Meta-regression analysis revealed that spirometry (as expressed by FEV₁%predicted) might influence on PWV.

CONCLUSIONS

These findings indicate that COPD, even in mild to moderate patients, had greater impaired markers of subclinical atherosclerosis and cardiovascular risk. However, further studies are still needed to address confounders, such as age, smoking, hypertension, diabetes etc, which might affect the associations in COPD patients.