1
|
Firincioglulari A, Erturk H, Firincioglulari M, Biber C. Evaluation of atherosclerosis as a risk factor in COPD patients by measuring the carotid intima-media thickness. Cardiovasc Ultrasound 2024; 22:2. [PMID: 38195448 PMCID: PMC10777512 DOI: 10.1186/s12947-023-00322-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/31/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND This study aimed to evaluate atherosclerosis as comorbidity by measuring the carotid (bulb and common carotid artery) Carotid intima-media thickness in COPD-diagnosed patients and to evaluate the relationship of atherosclerosis with the prevalence of COPD, hypoxemia and hypercapnia. METHODS This study was conducted out between January 2019-December 2019 consisting of a total of 140 participants (70 COPD-diagnosed patients-70 healthy individuals). The COPD-diagnosed patients have been planned according to the selection and diagnosis criteria as per the GOLD 2019 guide. It is planned to evaluate as per prospective matching case-control study of the carotid thickness, radial gas analysis, spirometric and demographic characteristics of COPD diagnosed patients and healthy individuals. RESULTS The average Carotid intima-media thickness in COPD patients was 0.8746±0.161 (p<0.05), and the thickness of the carotid bulb was 1.04±0.150 (p<0.05). In the control group, the average CCA intima-media thickness was 0.6650±0.139 (p<0.05), and the thickness of the carotid bulb was 0.8250±0.15(p<0.05) For the carotid thickness that has increased in COPD diagnosed patients a significant relationship is determined between hypoxemia (p<0.05) and hypercapnia(p<0.05). A significant relationship determined between CIMT and severity of COPD (p<0.05) The CIMT was high in COPD patients with hypoxemia and hypercapnia(p<0.05). CONCLUSION Significant difference was determined between the severity (grades) of COPD (mild, moderate, severe, very severe) in carotid thickness. Also, CIMT was found to be high in patients who is in the early phases of the prevalence of COPD. In COPD-diagnosed patients, it was determined that severity of COPD, hypoxemia, hypercapnia and age were determining factors of atherosclerosis.
Collapse
Affiliation(s)
- Ali Firincioglulari
- Department of Chest Diseases, Dr Burhan Nalbantoğlu State Hospital, Nicosia, Cyprus
| | - Hakan Erturk
- Department of Radiology, Health Sciences University, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Mujgan Firincioglulari
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Cyprus International University, Nicosia, Cyprus.
| | - Cigdem Biber
- Department of Chest Diseases, Health Sciences University, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
2
|
Desplanche E, Grillet PE, Wynands Q, Bideaux P, Alburquerque L, Charrabi A, Bourdin A, Cazorla O, Gouzi F, Virsolvy A. Elevated Blood Pressure Occurs without Endothelial Dysfunction in a Rat Model of Pulmonary Emphysema. Int J Mol Sci 2023; 24:12609. [PMID: 37628790 PMCID: PMC10454081 DOI: 10.3390/ijms241612609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/21/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease involving airway closure and parenchyma destruction (emphysema). Cardiovascular diseases are the main causes of morbi-mortality in COPD and, in particular, hypertension and heart failure with preserved ejection fraction (HFpEF). However, no mechanistic link has currently been established between the onset of COPD, elevated blood pressure (BP) and systemic vascular impairment (endothelial dysfunction). Thus, we aimed to characterize BP and vascular function and remodeling in a rat model of exacerbated emphysema focusing on the role of sympathetic hyperactivity. Emphysema was induced in male Wistar rats by four weekly pulmonary instillations of elastase (4UI) and exacerbation by a single dose of lipopolysaccharides (LPS). Five weeks following the last instillation, in vivo and ex vivo cardiac and vascular functions were investigated. Exacerbated emphysema induced cardiac dysfunction (HFpEF) and a BP increase in this COPD model. We observed vasomotor changes and hypotrophic remodeling of the aorta without endothelial dysfunction. Indeed, changes in contractile and vasorelaxant properties, though endothelium-dependent, were pro-relaxant and NO-independent. A β1-receptor antagonist (bisoprolol) prevented HFpEF and vascular adaptations, while the effect on BP increase was partial. Endothelial dysfunction would not trigger hypertension and HFpEF in COPD. Vascular changes appeared as an adaptation to the increased BP. The preventing effect of bisoprolol revealed a pivotal role of sympathetic hyperactivation in BP elevation. The mechanistic link between HFpEF, cardiac sympathetic activation and BP deserves further studies in this exacerbated-emphysema model, as well as in COPD patients.
Collapse
Affiliation(s)
- Elodie Desplanche
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Pierre-Edouard Grillet
- PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, 34295 Montpellier, France; (P.-E.G.); (A.B.); (F.G.)
| | - Quentin Wynands
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Patrice Bideaux
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Laurie Alburquerque
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Azzouz Charrabi
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Arnaud Bourdin
- PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, 34295 Montpellier, France; (P.-E.G.); (A.B.); (F.G.)
| | - Olivier Cazorla
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| | - Fares Gouzi
- PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, 34295 Montpellier, France; (P.-E.G.); (A.B.); (F.G.)
| | - Anne Virsolvy
- PhyMedExp, Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France; (E.D.); (Q.W.); (P.B.); (L.A.); (A.C.); (O.C.)
| |
Collapse
|
3
|
Eastus CC, Baez DE, Buckley ML, Lee J, Adami A. The role of structured exercise interventions on cognitive function in older individuals with stable Chronic Obstructive Pulmonary Disease: A scoping review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:987356. [PMID: 36386775 PMCID: PMC9659625 DOI: 10.3389/fresc.2022.987356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023]
Abstract
UNLABELLED A decline in cognitive performance has been associated with disease severity, exacerbations rate, presence of comorbidities, and low activity level in people with chronic obstructive pulmonary disease (COPD). Participation in exercise programs appears to have neuroprotective effects and to improve cognitive performance in older people. The present work undertook a scoping review of the effects of exercise-based interventions on cognitive function in older individuals with stable COPD. METHODS The methodological framework for scoping review was used and electronic searches of five databases performed. Original research and observational studies published between January 2010 and December 2021, administering exercise-based interventions and cognitive function evaluation, were included. RESULTS Of 13 full-text manuscripts assessed for eligibility, five were allocated to analysis. Three studies administered exercise training within pulmonary outpatient rehabilitation program (PR), and one inpatient PR. The fifth study conducted a structured training intervention in which either aerobic or a combination with resistance exercises were included. Twelve cognitive function screening tools were used in the five studies included in the analysis. Results extracted were based on 245 COPD (33% female) with moderate to very-severe airflow limitation. Interventions ranged from 12 to 36 sessions. Studies reported statistically significant improvements after intervention in different cognitive function domains, such as global cognition, immediate and delayed recall ability, cognitive flexibility, verbal fluency, attention, abstract reasoning, praxis ability. CONCLUSIONS Exercise-based interventions improve several areas of cognitive function in patients with stable COPD. However, the magnitude of gain varies among studies, and this is possibly due to the heterogeneity of tests used. Future research is needed to validate the optimal battery of screening tests, and to support the definition of guidelines for cognitive function evaluation in COPD.
Collapse
Affiliation(s)
- Caroline C. Eastus
- Department of Kinesiology, College of Health Sciences, University of Rhode Island, Kingston, RI, United States
| | - Daniel E. Baez
- Department of Kinesiology, College of Health Sciences, University of Rhode Island, Kingston, RI, United States
| | - Maria L. Buckley
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Jungeun Lee
- College of Nursing, University of Rhode Island, Kingston, RI, United States
| | - Alessandra Adami
- Department of Kinesiology, College of Health Sciences, University of Rhode Island, Kingston, RI, United States,Correspondence: Alessandra Adami
| |
Collapse
|
4
|
Relationship between chronic obstructive pulmonary disease and cognition in an aging population. J Psychosom Res 2022; 161:111000. [PMID: 35963125 DOI: 10.1016/j.jpsychores.2022.111000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) is a common and severe respiratory illness. Prior research suggests that COPD may be associated with depression as well as cognitive impairment and increased risk of dementia. Many studies to date have been relatively small, have largely relied on global screening measures to identify cognitive impairment, and have not examined the potential role of comorbid depression on cognition. This cross-sectional study examined the relationship between COPD and multiple cognitive domains at two time points using data from a large longitudinal population database. METHODS Linear multivariate analyses were conducted using secondary data from the Wisconsin Longitudinal Study to determine the effect of lifetime COPD and depressive symptom severity, assessed with the Center for Epidemiological Studies Depression Scale (CESD), on multiple cognitive outcomes. RESULTS In both 2004 (n = 1608) and 2011 (n = 1743), lifetime COPD was found to be a non-significant predictor of all cognitive outcomes, while depressive symptom severity predicted significantly lower scores on the immediate recall and digit ordering tasks in 2004 and on all outcomes in 2011. Exploratory analyses in only those with lifetime COPD revealed COPD severity to be a non-significant factor for all outcomes in 2004 and 2011. CONCLUSION COPD was not significantly associated with cognition. Conversely, higher depressive symptom severity was significantly associated with poorer performance on additional cognitive tasks in 2011 compared to 2004, suggesting that depression may contribute to cognitive decline, dependent upon the context of aging.
Collapse
|
5
|
Chronic obstructive pulmonary disease and atherosclerosis: common mechanisms and novel therapeutics. Clin Sci (Lond) 2022; 136:405-423. [PMID: 35319068 PMCID: PMC8968302 DOI: 10.1042/cs20210835] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/17/2022] [Accepted: 03/07/2022] [Indexed: 12/17/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) and atherosclerosis are chronic irreversible diseases, that share a number of common causative factors including cigarette smoking. Atherosclerosis drastically impairs blood flow and oxygen availability to tissues, leading to life-threatening outcomes including myocardial infarction (MI) and stroke. Patients with COPD are most likely to die as a result of a cardiovascular event, with 30% of all COPD-related deaths being attributed to cardiovascular disease (CVD). Both atherosclerosis and COPD involve significant local (i.e. lung, vasculature) and systemic inflammation and oxidative stress, of which current pharmacological treatments have limited efficacy, hence the urgency for the development of novel life-saving therapeutics. Currently these diseases must be treated individually, with no therapies available that can effectively reduce the likelihood of comorbid CVD other than cessation of cigarette smoking. In this review, the important mechanisms that drive atherosclerosis and CVD in people with COPD are explained and we propose that modulation of both the oxidative stress and the inflammatory burden will provide a novel therapeutic strategy to treat both the pulmonary and systemic manifestations related to these diseases.
Collapse
|
6
|
Zijlmans JL, Lamballais S, Vernooij MW, Ikram MA, Luik AI. Sociodemographic, Lifestyle, Physical, and Psychosocial Determinants of Cognitive Reserve. J Alzheimers Dis 2021; 85:701-713. [PMID: 34864674 PMCID: PMC8842775 DOI: 10.3233/jad-215122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive reserve aims to explain individual differences in the susceptibility to the functional impact of dementia in the presence of equal amount of neuropathological damage. It is thought to be shaped by a combination of innate individual differences and lifetime exposures. Which determinants are associated with cognitive reserve remains unknown. OBJECTIVE The objective of this study was to investigate the associations of sociodemographic, lifestyle, physical, and psychosocial determinants with cognitive reserve, and potential sex differences. METHODS This cross-sectional study included 4,309 participants from the Rotterdam Study (mean age 63.9±10.7) between 2006-2016. Participants completed five cognitive tests and a brain MRI-scan. Cognitive reserve was defined as a latent variable that captures variance common across five cognitive tests, while adjusting for demographic and MRI-inferred neuropathological factors. The associations of potential determinants and cognitive reserve, adjusted for relevant confounders, were assessed with structural equation models. RESULTS Current smoking (adjusted mean difference: -0.31, 95%confidence interval -0.42; -0.19), diabetes mellitus (-0.25, -0.40; -0.10) and depressive symptoms (-0.07/SD, -0.12; -0.03) were associated with a lower cognitive reserve whereas alcohol use (0.07/SD, 0.03; 0.12) was associated with higher cognitive reserve. Only smoking was associated with cognitive reserve in both men and women. Employment, alcohol use, diabetes, history of cancer, COPD, and depressive symptoms were only associated with cognitive reserve in women. CONCLUSION Our study found that current smoking, diabetes mellitus, and depressive symptoms were associated with a lower cognitive reserve, whereas more alcohol use was associated with a higher cognitive reserve, but with clear differences between men and women.
Collapse
Affiliation(s)
- Jendé L Zijlmans
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Sander Lamballais
- Department of Clinical Genetics, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.,Department of Radiology and nuclear medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| |
Collapse
|
7
|
Shnoda M, Gajjar K, Ivanova V. COPD and Cardiovascular Disease: A Review of Association, Interrelationship, and Basic Principles for Integrated Management. Crit Care Nurs Q 2021; 44:91-102. [PMID: 33234862 DOI: 10.1097/cnq.0000000000000342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The presence of comorbid cardiovascular disease (CVD) in patients with chronic obstructive pulmonary disease (COPD) can result in unfavorable outcomes, ranging from deterioration in quality of life to increases in all-cause and cardiovascular mortality. Moreover, cardiovascular events are major cause of hospitalization in patients with COPD and contributing significantly to the economic burden of the disease. Despite the acknowledgment of the prognostic significance of CVD comorbidity in COPD patients, CVD remains underrecognized and undertreated in this patient population. In this article, we address the current knowledge about the estimated prevalence, pathophysiologic association, as well as important considerations in the diagnosis and management of CVD in COPD patients.
Collapse
Affiliation(s)
- Mina Shnoda
- Divisions of Internal Medicine (Dr Shnoda) and Cardiovascular Institute (Drs Gajjar and Ivanova), Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | | |
Collapse
|
8
|
Watanabe K, Onoue A, Omori H, Kubota K, Yoshida M, Katoh T. Association Between Airflow Limitation and Carotid Intima-Media Thickness in the Japanese Population. Int J Chron Obstruct Pulmon Dis 2021; 16:715-726. [PMID: 33776430 PMCID: PMC7989542 DOI: 10.2147/copd.s291477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aimed to reveal the association between airflow limitation (AL) and carotid intima-media thickness (IMT) according to smoking status in Japan. SUBJECTS AND METHODS This cross-sectional study was performed in 2809 subjects, who underwent a comprehensive health examination with pulmonary function tests and carotid ultrasonographic measurement. AL was defined as forced expiratory volume in 1 s/forced vital capacity of <0.7. The subjects were divided into the following four groups: never smokers without AL, never smokers with AL, former/current smokers without AL, and former/current smokers with AL. Mean IMT, the maximum measurable IMT value in the left and right common carotid arteries (IMT-C max), and mean IMT-C max were measured by carotid ultrasonography. The carotid wall thickness as defined as follows: IMT ≥ 1.1 mm (IMT1.1), IMT-C max ≥ 1.2 mm (IMTc1.2), and IMT-C max > 1.5 mm (IMTc1.5), based on each measured region. The association between AL and the carotid wall thickness according to smoking status was assessed by logistic regression analysis. RESULTS The mean carotid IMT and mean IMT-C max were significantly higher in never smokers with AL and former/current smokers with or without AL than in never smokers without AL. In logistic regression models adjusted for sex, age, body mass index, hypertension, dyslipidemia, hyperglycemia, physical activity, and alcohol consumption, the risk of carotid wall thickness (IMT1.1 [odds ratio {OR}: 1.55; 95% confidence interval {CI}: 1.07-2.24]; IMTc1.2 [OR: 1.52; 95% CI: 1.03-2.24]; IMTc1.5 [OR: 1.99; 95% CI: 1.15-3.46]) were significantly higher in former/current smokers with AL than in never smokers without AL. CONCLUSION The present results suggest that greater IMT and risk of carotid wall thickness were associated with AL and smoking experience.
Collapse
Affiliation(s)
- Kazuhiko Watanabe
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Ayumi Onoue
- Department of Biomedical Laboratory Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisamitsu Omori
- Department of Biomedical Laboratory Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Kubota
- Japanese Red Cross Kumamoto Health Care Center, Kumamoto, Japan
| | - Minoru Yoshida
- Japanese Red Cross Kumamoto Health Care Center, Kumamoto, Japan
| | - Takahiko Katoh
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
9
|
Shafuddin E, Fairweather SM, Chang CL, Tuffery C, Hancox RJ. Cardiac biomarkers and long-term outcomes of exacerbations of COPD: a long-term follow-up of two cohorts. ERJ Open Res 2021; 7:00531-2020. [PMID: 33644222 PMCID: PMC7897844 DOI: 10.1183/23120541.00531-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/26/2020] [Indexed: 11/05/2022] Open
Abstract
Background COPD patients often have cardiac comorbidities. Cardiac involvement at the time of a COPD exacerbation is associated with a high short-term mortality, but whether this influences long-term outcomes is unknown. We explored whether biomarkers of cardiac dysfunction at the time of a COPD exacerbation predict long-term outcomes. Methods Two prospective cohorts of patients admitted to Waikato Hospital for exacerbations of COPD were recruited during 2006-2007 and 2012-2013. N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin T were measured on admission and were used to indicate cardiac stretch and myocardial injury, respectively. 5-year survival after discharge and subsequent admissions for cardiac disease and COPD exacerbations were analysed using Kaplan-Meier and Cox proportional hazards tests. Results The overall 5-year mortality was 61%. Patients with high NT-proBNP on admission had higher mortality than those with normal cardiac biomarkers (adjusted hazard ratio (aHR) 1.76, 95% CI 1.18-2.62). High NT-proBNP was also associated with a higher risk of future cardiac admissions (aHR 1.75, 95% CI 1.2-2.55). Troponin T levels were not associated with long-term survival (aHR 0.86, 95% CI 0.40-1.83) or future cardiac admissions (aHR 0.74, 95% CI 0.34-1.57). Neither biomarker predicted future COPD exacerbations. Conclusion The long-term prognosis following a hospitalisation for an exacerbation of COPD is poor with less than half of patients surviving for 5 years. Elevated NT-proBNP at the time of a COPD exacerbation is associated with higher long-term mortality and a greater likelihood of future cardiac admissions, but not future COPD exacerbations.
Collapse
Affiliation(s)
- Eskandarain Shafuddin
- Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand.,These authors contributed equally
| | - Sarah M Fairweather
- Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand.,These authors contributed equally
| | - Catherina L Chang
- Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
| | - Christine Tuffery
- Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
| | - Robert J Hancox
- Dept of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand.,Dept of Preventive and Social Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| |
Collapse
|
10
|
Stratev V, Dimitrova V, Petkova D. COPD and Comorbidities: Relating Mechanisms and Treatment. CURRENT RESPIRATORY MEDICINE REVIEWS 2019. [DOI: 10.2174/1573398x14666181018101021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Despite being a disease with the constantly rising social burden and mortality, COPD is
also associated with a number of other conditions known as comorbidities. COPD and other diseases
often share similar risk factors, such as smoking and aging, which leads to increased prevalence of
comorbidities. The key pathogenic mechanisms of COPD are chronic inflammation and oxidative
stress and they also contribute significantly to the development of accompanying diseases. Through
complex interactions, COPD increases the risk for certain comorbidities and they, in turn, have a
negative impact on health status and contribute to mortality in COPD patients. Proper treatment of
comorbidities may have a beneficial effect on COPD natural course and progression. Here we review
the prevalence of the most common comorbidities of COPD; their interrelating mechanism and the
current advances of the treatment in terms of co-existence.
Collapse
Affiliation(s)
- Velin Stratev
- Clinic of Pulmonary Diseases, University Hospital “St. Marina”, Varna, Bulgaria
| | - Valentina Dimitrova
- Clinic of Pulmonary Diseases, University Hospital “St. Marina”, Varna, Bulgaria
| | - Diana Petkova
- Clinic of Pulmonary Diseases, University Hospital “St. Marina”, Varna, Bulgaria
| |
Collapse
|
11
|
Tomaniak M, Chichareon P, Takahashi K, Kogame N, Modolo R, Chang CC, Spitzer E, Neumann FJ, Plante S, Hernández Antolin R, Jambrik Z, Gelev V, Brunel P, Konteva M, Beygui F, Morelle JF, Filipiak KJ, van Geuns RJ, Soliman O, Tijssen J, Rademaker-Havinga T, Storey RF, Hamm C, Steg PG, Windecker S, Onuma Y, Valgimigli M, Serruys PW. Impact of chronic obstructive pulmonary disease and dyspnoea on clinical outcomes in ticagrelor treated patients undergoing percutaneous coronary intervention in the randomized GLOBAL LEADERS trial. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2019; 6:222-230. [DOI: 10.1093/ehjcvp/pvz052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/30/2019] [Accepted: 12/09/2019] [Indexed: 12/21/2022]
Abstract
Abstract
Aims
To evaluate long-term safety and efficacy of ticagrelor monotherapy in patients undergoing percutaneous coronary interventions (PCIs) in relation to chronic obstructive pulmonary disease (COPD) at baseline and the occurrence of dyspnoea reported as adverse event (AE) that may lead to treatment non-adherence.
Methods and results
This is a non-prespecified, post hoc analysis of the randomized GLOBAL LEADERS trial (n = 15 991), comparing the experimental strategy of 23-month ticagrelor monotherapy following 1-month dual antiplatelet therapy (DAPT) after PCI with the reference strategy of 12-month DAPT followed by 12-month aspirin monotherapy. Impact of COPD and dyspnoea AE (as a time-dependent covariate) on clinical outcomes was evaluated up to 2 years. The primary endpoint was a 2-year all-cause mortality or non-fatal, centrally adjudicated, new Q-wave myocardial infarction. The presence of COPD (n = 832) was the strongest clinical predictor of 2-year all-cause mortality after PCI [hazard ratio (HR) 2.84; 95% confidence interval (CI) 2.21–3.66; P adjusted = 0.001] in this cohort (n = 15 991). No differential treatment effects on 2-year clinical outcomes were found in patients with and without COPD (primary endpoint: HR 0.88; 95% CI 0.58–1.35; P = 0.562; P int = 0.952). Overall, at 2 years dyspnoea was reported as an AE in 2101 patients, more frequently among COPD patients, irrespective of treatment allocation (27.2% in experimental arm vs. 14.5% in reference arm, P = 0.001). Its occurrence was not associated with a higher rate of the primary endpoint (P adjusted = 0.640) in the experimental vs. the reference arm.
Conclusion
In this exploratory analysis, COPD negatively impacted long-term prognosis after PCI. Despite higher incidence of dyspnoea in the experimental arm, in particular among COPD patients, the safety of the experimental treatment strategy appeared not to be affected.
Clinical trial registration unique identifier
NCT01813435.
Collapse
Affiliation(s)
- Mariusz Tomaniak
- Department of Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Ply Chichareon
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Norihiro Kogame
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rodrigo Modolo
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil
| | - Chun Chin Chang
- Department of Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
| | - Ernest Spitzer
- Department of Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
- Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, The Netherlands
| | | | - Sylvain Plante
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | | | - Zoltan Jambrik
- Békés Megyei Pándy Kálmán Kórház County Hospital, Gyula, Hungary
| | | | - Philippe Brunel
- Cardiologie Clinique Valmy Hopital Prive Dijon Bourgogne HPDB Dijon, Dijon, France
| | | | | | | | | | - Robert-Jan van Geuns
- Department of Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
- Department of Cardiology, Radboud UMC, Nijmegen, The Netherlands
| | - Osama Soliman
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Jan Tijssen
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, The Netherlands
| | | | - Robert F Storey
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
| | | | - Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular Trials), Université Paris Diderot, Hôpital Bichat, Assistance Publique—Hôpitaux de Paris, INSERM U-1148, Paris, France
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway, Galway, Ireland
- NHLI, Imperial College London, London, UK
| | | |
Collapse
|
12
|
Atherosclerotic calcification in major vessel beds in chronic obstructive pulmonary disease: The Rotterdam Study. Atherosclerosis 2019; 291:107-113. [DOI: 10.1016/j.atherosclerosis.2019.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/17/2019] [Accepted: 10/23/2019] [Indexed: 12/21/2022]
|
13
|
Yan X, Sun L, Ma M, Liu J, Wu S, Cao J. Relationship between pulmonary function and brachial-ankle pulse wave velocity in coal miners in northern China. J Thorac Dis 2019; 11:4551-4561. [PMID: 31903244 DOI: 10.21037/jtd.2019.10.71] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To investigate the relationship between pulmonary function and brachial-ankle pulse wave velocity (baPWV). Methods A cross-sectional study was conducted. A total of 11,388 people with complete pulmonary function test and baPWV data and who participated in both the health examination of the Kailuan Occupational Disease Prevention and Treatment Center in 2014-2016 and the health checkup of the Kailuan Group in 2012 and 2014 were selected as subjects. The study population was divided into four groups by forced vital capacity (FVC) quartiles (group 1: FVC <3.50 L; group 2: 3.50 L ≤ FVC <3.96 L; group 3: 3.96 L ≤ FVC <4.47 L; group 4: FVC ≥4.47 L) and divided into four groups by forced expiratory volume in one second (FEV1) quartile (group 1: FEV1 <3.15 L; group 2: 3.15 L ≤ FVC <3.61 L; group 3: 3.61 L ≤ FVC <4.08 L; group 4: FVC ≥4.08 L). Linear regression analysis and multivariate logistic regression were used to analyze the effects of pulmonary function on baPWV. Results When grouped by FVC, the baPWV of the first group was significantly higher than the other groups. Similarly, the incidence of arteriosclerosis in the first group was significantly higher than the other groups. When grouped by FEV1, the baPWV of the first group was significantly higher than the other groups. The incidence of arteriosclerosis was also significantly higher in the first group than the other groups. After correcting for other confounding factors using linear regression, it was found that the effects of FVC and FEV1 on the study subject's baPWV were -23.84 and -24.65 L, respectively. Multivariate logistic regression analysis showed that when grouped by FVC quartile, the risk of arteriosclerosis was increased by 34% in group 1 compared with group 4 (OR: 1.34, 95% CI: 1.17-1.52); the risk of arteriosclerosis was increased by 16% in group 2 compared with group 4 (OR: 1.16, 95% CI: 1.03-1.31). When grouped by the FEV1 quartile, the risk of arteriosclerosis was increased by 25% in group 1 compared with group 4 (OR: 1.25, 95% CI: 1.10-1.42). Conclusions Decreased pulmonary function is negatively correlated with baPWV and is an independent risk factor for arteriosclerosis.
Collapse
Affiliation(s)
- Xinhua Yan
- General Hospital of Tianjin Medical University, Tianjin 300070, China
| | - Lixia Sun
- Emergency Department, North China University of Science and Technology Affiliated Hospital, Tangshan 063009, China
| | - Mengying Ma
- Emergency Department, North China University of Science and Technology Affiliated Hospital, Tangshan 063009, China
| | - Jiqiang Liu
- Zhejiang Lishui Huaqiao Hospital, Lishui 323000, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan 063009, China
| | - Jie Cao
- General Hospital of Tianjin Medical University, Tianjin 300070, China
| |
Collapse
|
14
|
Brassington K, Selemidis S, Bozinovski S, Vlahos R. New frontiers in the treatment of comorbid cardiovascular disease in chronic obstructive pulmonary disease. Clin Sci (Lond) 2019; 133:885-904. [PMID: 30979844 PMCID: PMC6465303 DOI: 10.1042/cs20180316] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 02/06/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a disease characterised by persistent airflow limitation that is not fully reversible and is currently the fourth leading cause of death globally. It is now well established that cardiovascular-related comorbidities contribute to morbidity and mortality in COPD, with approximately 50% of deaths in COPD patients attributed to a cardiovascular event (e.g. myocardial infarction). Cardiovascular disease (CVD) and COPD share various risk factors including hypertension, sedentarism, smoking and poor diet but the underlying mechanisms have not been fully established. However, there is emerging and compelling experimental and clinical evidence to show that increased oxidative stress causes pulmonary inflammation and that the spill over of pro-inflammatory mediators from the lungs into the systemic circulation drives a persistent systemic inflammatory response that alters blood vessel structure, through vascular remodelling and arterial stiffness resulting in atherosclerosis. In addition, regulation of endothelial-derived vasoactive substances (e.g. nitric oxide (NO)), which control blood vessel tone are altered by oxidative damage of vascular endothelial cells, thus promoting vascular dysfunction, a key driver of CVD. In this review, the detrimental role of oxidative stress in COPD and comorbid CVD are discussed and we propose that targeting oxidant-dependent mechanisms represents a novel strategy in the treatment of COPD-associated CVD.
Collapse
Affiliation(s)
- Kurt Brassington
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
| | - Stavros Selemidis
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
| | - Steven Bozinovski
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
| | - Ross Vlahos
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
| |
Collapse
|
15
|
Keller K, Hobohm L, Münzel T, Ostad MA, Espinola-Klein C. Impact of chronic obstructive pulmonary disease on the outcomes of patients with peripheral artery disease. Respir Med 2018; 147:1-6. [PMID: 30704692 DOI: 10.1016/j.rmed.2018.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) and chronic obstructive pulmonary disease (COPD) are both related with high in-hospital mortality. We aimed to investigate the impact of COPD on the in-hospital outcomes in PAD. METHODS PAD patients were selected based on ICD-code I70.2 of the German nationwide database, stratified for COPD and compared regarding adverse in-hospital outcomes. RESULTS Between 01/2005-12/2015, 5,611,827 inpatients (64.8% males) were diagnosed with PAD; of those, 13.6% were coded additionally with COPD. Overall, 277,894 PAD patients (5.0%) died during in-hospital course. Prevalence of cardiovascular diseases as well as cancer (12.1% vs. 7.0%, P < 0.001) was higher in PAD patients with COPD compared to PAD patients without COPD. PAD patients with COPD showed more often lower PAD stages according to Fontaine classification (PAD stage I: 27.1% vs. 19.3%, P < 0.001; PAD stage IIa: 34.9% vs. 35.5%, P < 0.001; PAD stage IIb: 14.5% vs. 13.6%, P < 0.001; PAD stage III: 11.8% vs. 14.8%, P < 0.001; PAD stage IV: 13.8% vs. 19.6%, P < 0.001). The all-cause in-hospital mortality was significantly higher in PAD patients with COPD compared to those without COPD (6.5% vs. 4.7%, P < 0.001). Cardiovascular events comprising pulmonary embolism and myocardial infarction occurred more often in coprevalence with PAD and COPD. COPD was an independent predictor of in-hospital death (OR 1.16 (95%CI 1.15-1.17) P < 0.001) and an independent predictor for pulmonary embolism (PE, OR 1.44 (1.40-1.49), P < 0.001) in PAD patients. CONCLUSION COPD was associated with a high in-hospital mortality in PAD patients probably driven by higher frequencies of PE and cancer.
Collapse
Affiliation(s)
- Karsten Keller
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Mir Abolfazl Ostad
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Christine Espinola-Klein
- Department of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| |
Collapse
|
16
|
Bhatt SP, Nath HP, Kim YI, Ramachandran R, Watts JR, Terry NLJ, Sonavane S, Deshmane SP, Woodruff PG, Oelsner EC, Bodduluri S, Han MK, Labaki WW, Michael Wells J, Martinez FJ, Barr RG, Dransfield MT. Centrilobular emphysema and coronary artery calcification: mediation analysis in the SPIROMICS cohort. Respir Res 2018; 19:257. [PMID: 30563576 PMCID: PMC6299495 DOI: 10.1186/s12931-018-0946-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/20/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with a two-to-five fold increase in the risk of coronary artery disease independent of shared risk factors. This association is hypothesized to be mediated by systemic inflammation but this link has not been established. METHODS We included 300 participants enrolled in the SPIROMICS cohort, 75 each of lifetime non-smokers, smokers without airflow obstruction, mild-moderate COPD, and severe-very severe COPD. We quantified emphysema and airway disease on computed tomography, characterized visual emphysema subtypes (centrilobular and paraseptal) and airway disease, and used the Weston visual score to quantify coronary artery calcification (CAC). We used the Sobel test to determine whether markers of systemic inflammation mediated a link between spirometric and radiographic features of COPD and CAC. RESULTS FEV1/FVC but not quantitative emphysema or airway wall thickening was associated with CAC (p = 0.036), after adjustment for demographics, diabetes mellitus, hypertension, statin use, and CT scanner type. To explain this discordance, we examined visual subtypes of emphysema and airway disease, and found that centrilobular emphysema but not paraseptal emphysema or bronchial thickening was independently associated with CAC (p = 0.019). MMP3, VCAM1, CXCL5 and CXCL9 mediated 8, 8, 7 and 16% of the association between FEV1/FVC and CAC, respectively. Similar biomarkers partially mediated the association between centrilobular emphysema and CAC. CONCLUSIONS The association between airflow obstruction and coronary calcification is driven primarily by the centrilobular subtype of emphysema, and is linked through bioactive molecules implicated in the pathogenesis of atherosclerosis. TRIAL REGISTRATION ClinicalTrials.gov: Identifier: NCT01969344 .
Collapse
Affiliation(s)
- Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine and Lung Health Center, University of Alabama at Birmingham, THT 422, 1720, 2nd Avenue South, Birmingham, AL, 35294, USA.
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
| | - Hrudaya P Nath
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Young-Il Kim
- Division of Pulmonary, Allergy and Critical Care Medicine and Lung Health Center, University of Alabama at Birmingham, THT 422, 1720, 2nd Avenue South, Birmingham, AL, 35294, USA
- Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Rekha Ramachandran
- Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Jubal R Watts
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Nina L J Terry
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Sushil Sonavane
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Swati P Deshmane
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University California San Francisco, San Francisco, CA, 94143, USA
| | - Elizabeth C Oelsner
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, 10032, USA
| | - Sandeep Bodduluri
- Division of Pulmonary, Allergy and Critical Care Medicine and Lung Health Center, University of Alabama at Birmingham, THT 422, 1720, 2nd Avenue South, Birmingham, AL, 35294, USA
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - J Michael Wells
- Division of Pulmonary, Allergy and Critical Care Medicine and Lung Health Center, University of Alabama at Birmingham, THT 422, 1720, 2nd Avenue South, Birmingham, AL, 35294, USA
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
- Birmingham Veterans Affairs Hospital, Birmingham, AL, 35294, USA
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell School of Medicine, New York, NY, 10065, USA
| | - R Graham Barr
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY, 10032, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine and Lung Health Center, University of Alabama at Birmingham, THT 422, 1720, 2nd Avenue South, Birmingham, AL, 35294, USA
- UAB Lung Imaging Core, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
- Birmingham Veterans Affairs Hospital, Birmingham, AL, 35294, USA
| |
Collapse
|
17
|
Corlateanu A, Covantev S, Mathioudakis AG, Botnaru V, Cazzola M, Siafakas N. Chronic Obstructive Pulmonary Disease and Stroke. COPD 2018; 15:405-413. [PMID: 29746193 DOI: 10.1080/15412555.2018.1464551] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death in the world and its incidence and prevalence is on the rise. It is evident that COPD is linked to cardiovascular disease. In the last years, several studies demonstrated that COPD may also be a risk factor for stroke, another major cause of death worldwide. Taking in consideration that COPD has multiple comorbidities it is hard to say whether COPD is an independent risk factor for stroke or it is due to confounding effect. This review is aimed to discuss current data on COPD and stroke, potential links, therapy, and prevention. Current data suggest that COPD may increase the risk of hemorrhagic stroke. The incidence of other stroke subtypes may also be increased in COPD or may be due to confounding effect. However, COPD patients who have stroke are at risk for pulmonary and extrapulmonary complications. We conclude that more studies are needed to further clarify the links between COPD and stroke. The management of COPD as well as the use of prevention therapy is essential to decrease the risk for stroke and should be at special attention in pulmonary medicine and neurology.
Collapse
Affiliation(s)
- Alexandru Corlateanu
- a Department of Respiratory Medicine , State University of Medicine and Pharmacy "Nicolae Testemitanu ," Republic of Moldova, Chisinau , Moldova
| | - Serghei Covantev
- a Department of Respiratory Medicine , State University of Medicine and Pharmacy "Nicolae Testemitanu ," Republic of Moldova, Chisinau , Moldova
| | | | - Victor Botnaru
- a Department of Respiratory Medicine , State University of Medicine and Pharmacy "Nicolae Testemitanu ," Republic of Moldova, Chisinau , Moldova
| | - Mario Cazzola
- c Department of Systems Medicine , Università degli Studi di Roma "Tor Vergata," Rome , Italy
| | - Nikolaos Siafakas
- d University General Hospital , Department of Thoracic Medicine, Stavrakia , Heraklion , Greece
| |
Collapse
|
18
|
Fisk M, Cheriyan J, Mohan D, McEniery CM, Forman J, Cockcroft JR, Rudd JHF, Tal-Singer R, Hopkinson NS, Polkey MI, Wilkinson IB. Vascular inflammation and aortic stiffness: potential mechanisms of increased vascular risk in chronic obstructive pulmonary disease. Respir Res 2018; 19:100. [PMID: 29793484 PMCID: PMC5968523 DOI: 10.1186/s12931-018-0792-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 04/27/2018] [Indexed: 01/09/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a complex inflammatory condition in which an important extra-pulmonary manifestation is cardiovascular disease. We hypothesized that COPD patients would have increased aortic inflammation and stiffness, as candidate mechanisms mediating increased cardiovascular risk, compared to two negative control groups: healthy never-smokers and smokers without COPD. We also studied patients with COPD due to alpha− 1 antitrypsin deficiency (α1ATD) as a comparator lung disease group. Methods Participants underwent 18F-Fluorodeoxyglucose (FDG) positron emission tomography imaging to quantify aortic inflammation as the tissue-to-blood-ratio (TBR) of FDG uptake. Aortic stiffness was measured by carotid-femoral aortic pulse wave velocity (aPWV). Results Eighty-five usual COPD (COPD due to smoking), 12 α1ATD-COPD patients and 12 each smokers and never-smokers were studied. There was no difference in pack years smoked between COPD patients and smokers (45 ± 25 vs 37 ± 19, p = 0.36), but α1ATD patients smoked significantly less (19 ± 11, p < 0.001 for both). By design, spirometry measures were lower in COPD and α1ATD-COPD patients compared to smokers and never-smokers. Aortic inflammation and stiffness were increased in COPD (TBR: 1.90 ± 0.38, aPWV: 9.9 ± 2.6 m/s) and α1ATD patients (TBR: 1.94 ± 0.43, aPWV: 9.5 ± 1.8 m/s) compared with smokers (TBR: 1.74 ± 0.30, aPWV: 7.8 ± 1.8 m/s, p < 0.05 all) and never-smokers (TBR: 1.71 ± 0.34, aPWV: 7.9 ± 1.7 m/s, p ≤ 0.05 all). Conclusions In this cross-sectional prospective study, novel findings were that both usual COPD and α1ATD-COPD patients have increased aortic inflammation and stiffness compared to smoking and never-smoking controls, regardless of smoking history. These findings suggest that the presence of COPD lung disease per se may be associated with adverse aortic wall changes, and aortic inflammation and stiffening are potential mechanisms mediating increased vascular risk observed in COPD patients. Electronic supplementary material The online version of this article (10.1186/s12931-018-0792-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Marie Fisk
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK.
| | - Joseph Cheriyan
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK.,Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Divya Mohan
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK.,GSK R&D, King of Prussia, Pennsylvania, USA
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK
| | - Julia Forman
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - John R Cockcroft
- Department of Cardiology, Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge & Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Nicholas S Hopkinson
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, UK.,Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
19
|
Izzy S, Rubin DB, Ahmed FS, Akbik F, Renault S, Sylvester KW, Vaitkevicius H, Smallwood JA, Givertz MM, Feske SK. Cerebrovascular Accidents During Mechanical Circulatory Support. Stroke 2018; 49:1197-1203. [DOI: 10.1161/strokeaha.117.020002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/03/2018] [Accepted: 03/12/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Saef Izzy
- From the Department of Neurology, Brigham and Women’s Hospital, Boston, MA (S.I., D.B.R., F.A., H.V., S.K.F.)
| | - Daniel B. Rubin
- From the Department of Neurology, Brigham and Women’s Hospital, Boston, MA (S.I., D.B.R., F.A., H.V., S.K.F.)
- Department of Neurology, Massachusetts General Hospital, Boston (D.B.R., F.A.)
| | - Firas S. Ahmed
- Department of Radiology, Columbia University Medical Center, New York, NY (F.S.A.)
| | - Feras Akbik
- From the Department of Neurology, Brigham and Women’s Hospital, Boston, MA (S.I., D.B.R., F.A., H.V., S.K.F.)
- Department of Neurology, Massachusetts General Hospital, Boston (D.B.R., F.A.)
| | | | - Katelyn W. Sylvester
- Department of Pharmacy Services, Brigham and Women’s Hospital, Boston, MA (K.W.S.)
| | - Henrikas Vaitkevicius
- From the Department of Neurology, Brigham and Women’s Hospital, Boston, MA (S.I., D.B.R., F.A., H.V., S.K.F.)
| | - Jennifer A. Smallwood
- Department of Preventative Medicine & Epidemiology, Boston University School of Medicine, MA (J.A.S.)
| | - Michael M. Givertz
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, MA (M.M.G.)
| | - Steven K. Feske
- From the Department of Neurology, Brigham and Women’s Hospital, Boston, MA (S.I., D.B.R., F.A., H.V., S.K.F.)
| |
Collapse
|
20
|
Kim YR, Hwang IC, Lee YJ, Ham EB, Park DK, Kim S. Stroke risk among patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Clinics (Sao Paulo) 2018; 73:e177. [PMID: 29723340 PMCID: PMC5910631 DOI: 10.6061/clinics/2018/e177] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/27/2017] [Indexed: 11/26/2022] Open
Abstract
Increased stroke risk among chronic obstructive pulmonary disease patients has not yet been established. In this study, we conducted a systematic review and meta-analysis to assess stroke risk among chronic obstructive pulmonary disease patients. PubMed, EMBASE, and the Cochrane Library were systematically searched from database inception until December 31, 2016 to identify longitudinal observational studies that investigated the association between chronic obstructive pulmonary disease and stroke. Stroke risk was quantified by overall and subgroup analyses, and a pooled hazard ratio was calculated. Study quality was evaluated using the Newcastle-Ottawa Scale. Publication bias was assessed using Begg's rank correlation test. Eight studies met the inclusion criteria. In a random-effects model, significantly increased stroke risk was observed among chronic obstructive pulmonary disease patients (hazard ratio, 1.30; 95% confidence interval, 1.18-1.43). In subgroup analyses stratified by stroke subtype, study quality, and adjustment by socioeconomic status, the association between increased stroke risk and chronic obstructive pulmonary disease patients was robust. Statistically significant publication bias was not detected. In summary, chronic obstructive pulmonary disease was found to be associated with increased stroke risk. Additional prospective studies are required to elucidate the mechanisms underlying the increase in stroke risk and identify effective preventive interventions.
Collapse
Affiliation(s)
- Yu Ree Kim
- Department Family Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - In Cheol Hwang
- Department Family Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
- *Corresponding author. E-mail:
| | - Yong Joo Lee
- Department of Family Medicine, Catholic University Seoul St. Mary’s Hospital, Seoul, Republic of Korea
- #These authors contributed equally to this work
| | - Eun Bee Ham
- Department Family Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Dong Kyun Park
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Sewan Kim
- Shingil Yonsei Clinic, Seoul, Republic of Korea
| |
Collapse
|
21
|
Brusselle G, Bracke K, De Pauw M. Peripheral Artery Disease in Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2017; 195:148-150. [PMID: 28084818 DOI: 10.1164/rccm.201608-1712ed] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Guy Brusselle
- 1 Ghent University Hospital Ghent, Belgium and.,2 Erasmus Medical Center Rotterdam, the Netherlands
| | - Ken Bracke
- 1 Ghent University Hospital Ghent, Belgium and
| | | |
Collapse
|
22
|
Ikram MA, Brusselle GGO, Murad SD, van Duijn CM, Franco OH, Goedegebure A, Klaver CCW, Nijsten TEC, Peeters RP, Stricker BH, Tiemeier H, Uitterlinden AG, Vernooij MW, Hofman A. The Rotterdam Study: 2018 update on objectives, design and main results. Eur J Epidemiol 2017; 32:807-850. [PMID: 29064009 PMCID: PMC5662692 DOI: 10.1007/s10654-017-0321-4] [Citation(s) in RCA: 338] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/06/2017] [Indexed: 02/07/2023]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1500 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
Collapse
Affiliation(s)
- M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Guy G O Brusselle
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Sarwa Darwish Murad
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Gastro-Enterology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - André Goedegebure
- Department of Otolaryngology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tamar E C Nijsten
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - André G Uitterlinden
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
23
|
Ambrosino P, Lupoli R, Cafaro G, Iervolino S, Carone M, Pappone N, Di Minno MND. Subclinical carotid atherosclerosis in patients with chronic obstructive pulmonary disease: a meta-analysis of literature studies. Ann Med 2017; 49:513-524. [PMID: 28326854 DOI: 10.1080/07853890.2017.1311022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) patients have an increased cardiovascular (CV) morbidity and mortality. Common carotid intima-media thickness (CCA-IMT) and carotid plaques are surrogate markers of subclinical atherosclerosis and predictors of CV events. METHODS AND RESULTS We performed a meta-analysis to evaluate the association between COPD and subclinical atherosclerosis. Studies evaluating the impact of COPD on CCA-IMT and on the prevalence of carotid plaques were systematically searched. RESULTS Twenty studies (2082 COPD patients and 4844 controls) were included, 12 studies with data on CCA-IMT (13 data-sets on 1180 COPD patients and 2312 controls) and 12 studies reporting on the prevalence of carotid plaques (1231 COPD patients and 4222 controls). Compared to controls, COPD patients showed a significantly higher CCA-IMT (mean difference [MD]: 0.201 mm; 95%CI: 0.142, 0.260; p < .001), and an increased prevalence of carotid plaques (Odds Ratio [OR]: 2.503; 95%CI: 1.333, 2.175; p < .0001). Meta-regression models showed a direct association between disease severity [as expressed by Global Initiative for Chronic Obstructive Lung Disease (GOLD) class] and the difference in the risk of carotid plaques presence between COPD patients and controls. CONCLUSIONS COPD is significantly associated with subclinical atherosclerosis. These findings may be useful to plan adequate CV prevention strategies. Key messages COPD patients show a higher CCA-IMT and an increased prevalence of carotid plaques compared with controls. A more severe pulmonary disease is associated with a higher prevalence of carotid plaques in COPD patients. Screening for subclinical atherosclerosis may be worthy in COPD patients to plan specific prevention strategies.
Collapse
Affiliation(s)
- Pasquale Ambrosino
- a Department of Clinical Medicine and Surgery , Federico II University , Naples , Italy.,b ICS Maugeri SpA SB, Scientific Institute of Telese Terme - IRCCS , Telese Terme (BN) , Italy
| | - Roberta Lupoli
- a Department of Clinical Medicine and Surgery , Federico II University , Naples , Italy
| | - Giovanni Cafaro
- a Department of Clinical Medicine and Surgery , Federico II University , Naples , Italy
| | - Salvatore Iervolino
- b ICS Maugeri SpA SB, Scientific Institute of Telese Terme - IRCCS , Telese Terme (BN) , Italy
| | - Mauro Carone
- c ICS Maugeri SpA SB, Scientific Institute of Cassano delle Murge - IRCCS , Cassano delle Murge (BA) , Italy
| | - Nicola Pappone
- b ICS Maugeri SpA SB, Scientific Institute of Telese Terme - IRCCS , Telese Terme (BN) , Italy
| | | |
Collapse
|
24
|
Kudo K, Hata J, Matsumoto K, Shundo Y, Fukuyama S, Inoue H, Kitazono T, Kiyohara Y, Ninomiya T, Nakanishi Y. Association of Airflow Limitation With Carotid Atherosclerosis in a Japanese Community - The Hisayama Study. Circ J 2017; 81:1846-1853. [PMID: 28592724 DOI: 10.1253/circj.cj-16-1305] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There has been no large-scale observational study examining the association between chronic obstructive pulmonary disease (COPD) or airflow limitation and carotid atherosclerosis in the general population across a wide range of generations in Asia. In the present study we assessed the association between airflow limitation and carotid intima-media thickness (IMT) in a general Japanese population, with consideration of a comprehensive array of cardiovascular risk factors.Methods and Results:In all, 2,099 community-dwelling Japanese subjects were included in the study. Airflow limitation was defined by spirometry. Maximum and mean IMT values were measured using carotid ultrasonography. Among the subjects, 352 (16.8%) had airflow limitation. The geometric mean values of maximum IMT and mean IMT were significantly higher in subjects with than without airflow limitation (1.27 vs. 1.18 mm, respectively, for maximum IMT; 0.73 mm vs. 0.72 mm, respectively, for mean IMT) and increased with the severity of airflow limitation after adjustment for conventional risk factors, including smoking habits and serum high-sensitivity C-reactive protein. It should be noted that the magnitude of these associations was greater in the middle-aged (40-64 years) than elderly (≥65 years) subgroup. CONCLUSIONS The findings of the present study suggest that airflow limitation is a significant risk factor for carotid atherosclerosis, especially in midlife, in the general Japanese population.
Collapse
Affiliation(s)
- Kunihiro Kudo
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University.,Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | - Koichiro Matsumoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University
| | - Yuki Shundo
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University.,Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Satoru Fukuyama
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University
| | - Hiromasa Inoue
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Takanari Kitazono
- Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
| | | | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University
| | - Yoichi Nakanishi
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University
| |
Collapse
|
25
|
Vascular disease in COPD: Systemic and pulmonary expression of PARC (Pulmonary and Activation-Regulated Chemokine). PLoS One 2017; 12:e0177218. [PMID: 28545096 PMCID: PMC5436690 DOI: 10.1371/journal.pone.0177218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 04/24/2017] [Indexed: 12/12/2022] Open
Abstract
Introduction The role of Pulmonary and Activation-Regulated Chemokine (PARC) in the physiopathology of Chronic Obstructive Pulmonary Disease (COPD) is not fully understood. The aim of the present study is to analyze the expression of PARC in lung tissue and its relationship with the vascular remodeling of the systemic and pulmonary arteries of COPD subjects. Methods To achieve this objective, protein and gene expression experiments, together with ELISA assays, were performed on the lung tissue, intercostal arteries and serum samples from COPD patients, non-obstructed smokers (NOS) and never-smokers (NS). Results A total of 57 subjects were included in the analysis (23 COPD, 18 NOS and 16 NS). In the comparisons between groups, a significantly increased lung protein expression of PARC was observed in the COPD group compared to the NOS group (1.96±0.22 vs. 1.29±0.27, P-adjusted = 0.038). PARC was located predominantly in the smooth muscle cells of the remodeled pulmonary muscular arteries and the macrophage-rich area of the alveolar parenchyma. No differences were detected in PARC gene expression analyses. The protein content of PARC in the intercostal arteries were similar between groups, though little remodeling was observed in these arteries. Circulating levels of PARC were numerically higher in patients with COPD compared to NOS and NS. Conclusion The results of the present study suggest an increased lung protein expression of PARC in COPD subjects. This protein was mainly localized in the smooth muscle cells of the pulmonary muscular arteries and was associated with the severity of intimal thickening, indicating its possible role in this remodeling process.
Collapse
|
26
|
Subclinical Carotid Atherosclerosis in COPD Cases and Control Smokers: Analysis in Relation with COPD Exacerbations and Exacerbation-like Episodes. Lung 2017; 195:185-191. [DOI: 10.1007/s00408-017-9986-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
|
27
|
Wells A, Romberger DJ, Thiele GM, Wyatt TA, Staab E, Heires AJ, Klassen LW, Duryee MJ, Mikuls TR, Dusad A, West WW, Wang D, Poole JA. Systemic IL-6 Effector Response in Mediating Systemic Bone Loss Following Inhalation of Organic Dust. J Interferon Cytokine Res 2016; 37:9-19. [PMID: 27875664 DOI: 10.1089/jir.2016.0048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Airway and skeletal diseases are prominent among agriculture workers. Repetitive inhalant exposures to agriculture organic dust extract (ODE) induces bone deterioration in mice; yet the mechanisms responsible for connecting the lung-bone inflammatory axis remain unclear. We hypothesized that the interleukin (IL)-6 effector response regulates bone deterioration following inhalant ODE exposures. Using an established intranasal inhalation exposure model, wild-type (WT) and IL-6 knockout (KO) mice were treated daily with ODE or saline for 3 weeks. ODE-induced airway neutrophil influx, cytokine/chemokine release, and lung pathology were not reduced in IL-6 KO animals compared to WT mice. Utilizing micro-computed tomography, analysis of tibia showed that loss of bone mineral density, volume, and deterioration of bone micro-architecture, and mechanical strength induced by inhalant ODE exposures in WT mice were absent in IL-6 KO animals. Compared to saline treatments, bone-resorbing osteoclasts and bone marrow osteoclast precursor populations were also increased in ODE-treated WT but not IL-6 KO mice. These results show that the systemic IL-6 effector pathway mediates bone deterioration induced by repetitive inhalant ODE exposures through an effect on osteoclasts, but a positive role for IL-6 in the airway was not demonstrated. IL-6 might be an important link in explaining the lung-bone inflammatory axis.
Collapse
Affiliation(s)
- Adam Wells
- 1 Pulmonary, Critical Care, Sleep & Allergy Division, University of Nebraska Medical Center , The Nebraska Medical Center, Omaha, Nebraska
| | - Debra J Romberger
- 1 Pulmonary, Critical Care, Sleep & Allergy Division, University of Nebraska Medical Center , The Nebraska Medical Center, Omaha, Nebraska.,2 Veterans Affairs Nebraska-Western Iowa Health Care System , Omaha, Nebraska
| | - Geoffrey M Thiele
- 2 Veterans Affairs Nebraska-Western Iowa Health Care System , Omaha, Nebraska.,3 Rheumatology Division, Department of Medicine, University of Nebraska Medical Center , The Nebraska Medical Center, Omaha, Nebraska
| | - Todd A Wyatt
- 1 Pulmonary, Critical Care, Sleep & Allergy Division, University of Nebraska Medical Center , The Nebraska Medical Center, Omaha, Nebraska.,2 Veterans Affairs Nebraska-Western Iowa Health Care System , Omaha, Nebraska.,4 Department of Environmental, Agricultural, and Occupational Health, University of Nebraska Medical Center , The Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth Staab
- 1 Pulmonary, Critical Care, Sleep & Allergy Division, University of Nebraska Medical Center , The Nebraska Medical Center, Omaha, Nebraska
| | - Art J Heires
- 1 Pulmonary, Critical Care, Sleep & Allergy Division, University of Nebraska Medical Center , The Nebraska Medical Center, Omaha, Nebraska.,2 Veterans Affairs Nebraska-Western Iowa Health Care System , Omaha, Nebraska
| | - Lynell W Klassen
- 2 Veterans Affairs Nebraska-Western Iowa Health Care System , Omaha, Nebraska.,3 Rheumatology Division, Department of Medicine, University of Nebraska Medical Center , The Nebraska Medical Center, Omaha, Nebraska
| | - Michael J Duryee
- 2 Veterans Affairs Nebraska-Western Iowa Health Care System , Omaha, Nebraska.,3 Rheumatology Division, Department of Medicine, University of Nebraska Medical Center , The Nebraska Medical Center, Omaha, Nebraska
| | - Ted R Mikuls
- 2 Veterans Affairs Nebraska-Western Iowa Health Care System , Omaha, Nebraska.,3 Rheumatology Division, Department of Medicine, University of Nebraska Medical Center , The Nebraska Medical Center, Omaha, Nebraska
| | - Anand Dusad
- 3 Rheumatology Division, Department of Medicine, University of Nebraska Medical Center , The Nebraska Medical Center, Omaha, Nebraska
| | - William W West
- 5 Department of Pathology and Microbiology, University of Nebraska Medical Center , The Nebraska Medical Center, Omaha, Nebraska
| | - Dong Wang
- 6 Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center , The Nebraska Medical Center, Omaha, Nebraska
| | - Jill A Poole
- 1 Pulmonary, Critical Care, Sleep & Allergy Division, University of Nebraska Medical Center , The Nebraska Medical Center, Omaha, Nebraska
| |
Collapse
|
28
|
Pelisek J, Wendorff H, Wendorff C, Kuehnl A, Eckstein HH. Age-associated changes in human carotid atherosclerotic plaques. Ann Med 2016; 48:541-551. [PMID: 27595161 DOI: 10.1080/07853890.2016.1204468] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Little is known about changes in carotid plaque morphology during aging and the possible impact on cardiovascular events. Only few studies addressed so far age-related modifications within atherosclerotic lesions. Therefore, in this work we endeavored to summarize the current knowledge about changing of plaque composition in elderly. The data from hitherto existing studies confirm that atherosclerotic plaques undergo distinct alternations with advanced age. However, the results are often ambiguous and the changes do not seem to be as disastrous as expected. Interestingly, none of the studies could definitely evidence increased plaque vulnerability with advanced age. Nevertheless, based on the previous work showing decrease in elastin fibers, fibroatheroma, SMCs, overall cellularity and increase in the area of lipid core, hemorrhage, and calcification, the plaque morphology appears to transform toward unstable plaques. Otherwise, even if inflammatory cells often accumulate in plaques of younger patients, their amount is reduced in the older age and so far no clear association has been observed between thin fibrous cap and aging. Thus, the accurate contribution of age-related changes in plaque morphology to cardiovascular events has yet to be elucidated. KEY MESSAGES Composition of carotid atherosclerotic lesions changes during aging. These alternations are however, just moderate and depend upon additional variables, such as life style, accompanying disease, genetics, and other factors that have yet to be determined. Based on the current data, the age-associated plaque morphology seems to transform toward vulnerable plaques. However, the changes do not seem to be as disastrous as expected.
Collapse
Affiliation(s)
- Jaroslav Pelisek
- a Department of Vascular and Endovascular Surgery , Klinikum rechts der Isar der Technischen Universitaet Muenchen , Munich , Germany
| | - Heiko Wendorff
- a Department of Vascular and Endovascular Surgery , Klinikum rechts der Isar der Technischen Universitaet Muenchen , Munich , Germany
| | - Carina Wendorff
- a Department of Vascular and Endovascular Surgery , Klinikum rechts der Isar der Technischen Universitaet Muenchen , Munich , Germany
| | - Andreas Kuehnl
- a Department of Vascular and Endovascular Surgery , Klinikum rechts der Isar der Technischen Universitaet Muenchen , Munich , Germany
| | - Hans-Henning Eckstein
- a Department of Vascular and Endovascular Surgery , Klinikum rechts der Isar der Technischen Universitaet Muenchen , Munich , Germany
| |
Collapse
|
29
|
Lahousse L, Moyse E, Krantic S, Brusselle GG. Understanding age-related diseases: report of the 2015 Ageing Summit. Eur Respir J 2016; 47:5-9. [PMID: 26721954 DOI: 10.1183/13993003.00837-2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lies Lahousse
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium Erasmus Medical Center, Dept of Epidemiology, CA Rotterdam, The Netherlands
| | - Emmanuel Moyse
- PRC Laboratory, University François Rabelais/Centre INRA of Tours, Nouzilly, France Cordeliers Faculty of Medicine, University Paris-Descartes, Paris, France
| | - Slavica Krantic
- Cordeliers Research Centre, INSERM-Paris-Descartes-University, Paris, France
| | - Guy G Brusselle
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium Erasmus Medical Center, Dept of Epidemiology, CA Rotterdam, The Netherlands Dept of Respiratory Medicine, Erasmus Medical Center, CA Rotterdam, The Netherlands
| |
Collapse
|
30
|
Pizarro C, Linnhoff F, van Essen F, Pingel S, Schaefer CA, Schahab N, Fimmers R, Nickenig G, Skowasch D. Lower extremity and carotid artery disease in COPD. ERJ Open Res 2016; 2:00037-2016. [PMID: 28053972 PMCID: PMC5152848 DOI: 10.1183/23120541.00037-2016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022] Open
Abstract
In view of their common chronic inflammatory process, we sought to determine the linkage between peripheral artery disease and chronic obstructive pulmonary disease (COPD). 107 COPD patients (mean±sd age 64.6±10.4 years, 52.2% male) and 22 control smokers without previously diagnosed peripheral artery disease underwent standardised angiological examination for lower extremity artery disease (LEAD) and carotid artery disease. LEAD was significantly more prevalent in COPD patients than in controls (80.4% versus 54.5%, p=0.002). Among COPD patients, 57.0%, 12.2%, 10.3% and 0.9% were found to be in Fontaine stages I, IIA, IIB and III, respectively. As with carotid artery disease, its frequency increased from 36.4% in controls to 58.9% in COPD patients (p=0.003). Carotid plaque burden, LEAD Fontaine degrees as well as pulse wave index and ankle-brachial index manifested significant impairment over percentage predicted forced expiratory volume in 1 s (FEV1 % pred) (p=0.02, p<0.001, p=0.01 and p<0.001, respectively). Multivariate analysis revealed that COPD Global Initiative for Chronic Obstructive Lung Disease status was the strongest independent predictor for the presence of plaque in lower extremity arteries (odds ratio 1.63, 95% CI 1.19-2.25, p=0.003) and carotids (odds ratio 1.66, 95% CI 1.14-2.44, p=0.009). As compared with control smokers, peripheral artery disease is diagnosed in a sizeable proportion of COPD patients and exhibits significant distributive differences over FEV1 % pred that exceed the susceptibility conferred by common cardiovascular stressors.
Collapse
Affiliation(s)
- Carmen Pizarro
- Dept of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany
- These authors contributed equally to this work
| | - Fabian Linnhoff
- Dept of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany
- These authors contributed equally to this work
| | - Fabian van Essen
- Dept of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Simon Pingel
- Dept of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany
| | | | - Nadjib Schahab
- Dept of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Dept of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany
| | - Dirk Skowasch
- Dept of Internal Medicine II, Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
31
|
Köseoğlu C, Kurmuş Ö, Ertem AG, Çolak B, Bilen E, İpek G, Durmaz T, Keleş T, Bozkurt E. Association between carotid intima-media thickness and presence of coronary artery disease in chronic obstructive pulmonary disease patients. Anatol J Cardiol 2016; 16:601-607. [PMID: 27004706 PMCID: PMC5368517 DOI: 10.5152/anatoljcardiol.2015.6440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is a risk factor for cardiovascular disease (CVD). Carotid intima-media thickness (CIMT) is the sign of subclinical atherosclerosis. Therefore, the aim of this study was to evaluate whether CIMT measurement is related with significant coronary artery disease (CAD) in patients with COPD, similar to those without COPD. METHODS One hundred and eight patients with previously diagnosed COPD and 78 patients without COPD who underwent coronary angiography (CAG) were enrolled in this prospective cross-sectional study. Carotid artery ultrasonography was performed on all patients after coronary angiography by another operator who was blind to the CAG results. The patients were divided into four subgroups as follows: group 1: COPD (-) and CAD (-); group 2: COPD (-) and CAD (+); group 3: COPD (+) and CAD (+); and group 4: COPD (+) and CAD (-). Patients with previous coronary revascularization, carotid artery disease, and lung disease other than COPD were not enrolled in this study. The student's t-test, chi-square analysis, multiple logistic regression analysis, and receiver operating characteristic (ROC) curve were used for statistical analysis. RESULTS CIMT was found to be highest in patients with both significant CAD and COPD (group 3) (p<0.05). Among the 108 COPD patients, the odds ratio associated with the CIMT >1.25 mm to predict CAD was 12.4. The area under the ROC curve for a cut-off value of 1.25 mm for CIMT to predict CAD in COPD patients was calculated as 0.913, with a sensitivity of 89.7% and specificity of 86.7%. CONCLUSION CIMT has a predictive value for the presence of CAD in patients with COPD. Further studies are needed to validate our results.
Collapse
Affiliation(s)
- Cemal Köseoğlu
- Department of Cardiology, Ankara Training and Research Hospital, Ankara-Turkey
| | - Özge Kurmuş
- Department of Cardiology, Tarsus State Hospital, Mersin-Turkey.
| | - Ahmet Göktuğ Ertem
- Department of Cardiology, Atatürk Training and Research Hospital, Ankara-Turkey
| | - Büşra Çolak
- Department of Cardiology, Atatürk Training and Research Hospital, Ankara-Turkey
| | - Emine Bilen
- Department of Cardiology, Atatürk Training and Research Hospital, Ankara-Turkey
| | - Göktürk İpek
- Siyami Ersek Thoracic and Cardiovascular Surgery Centre, Training and Research Hospital, İstanbul-Turkey
| | - Tahir Durmaz
- Department of Cardiology, Atatürk Training and Research Hospital, Ankara-Turkey
| | - Telat Keleş
- Department of Cardiology, Atatürk Training and Research Hospital, Ankara-Turkey
| | - Engin Bozkurt
- Department of Cardiology, Atatürk Training and Research Hospital, Ankara-Turkey
| |
Collapse
|
32
|
Portegies MLP, Lahousse L, Joos GF, Hofman A, Koudstaal PJ, Stricker BH, Brusselle GG, Ikram MA. Chronic Obstructive Pulmonary Disease and the Risk of Stroke. The Rotterdam Study. Am J Respir Crit Care Med 2016; 193:251-8. [PMID: 26414484 DOI: 10.1164/rccm.201505-0962oc] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Worldwide, chronic obstructive pulmonary disease (COPD) and stroke are leading causes of death. Increasing evidence suggests an association between both diseases, either caused by an increased atherosclerosis risk in patients with COPD or as a consequence of shared risk factors between stroke and COPD. OBJECTIVES To examine the associations between COPD and subtypes of stroke in the general population and to explore the role of cardiovascular risk factors and exacerbations on these associations. METHODS Within the prospective population-based Rotterdam Study, we followed 13,115 participants without history of stroke for occurrence of stroke. Follow up started in 1990 to 2008 and ended in 2012. COPD was related to stroke using a time-dependent Cox proportional hazard model. MEASUREMENTS AND MAIN RESULTS COPD was diagnosed in 1,566 participants. During 126,347 person-years, 1,250 participants suffered a stroke, of which 701 were ischemic and 107 hemorrhagic. Adjusted for age, age squared, and sex, COPD was significantly associated with all stroke (hazard ratio [HR], 1.20; 95% confidence interval, 1.00-1.43), ischemic stroke (HR, 1.27; 1.02-1.59), and hemorrhagic stroke (HR, 1.70; 1.01-2.84). Adjusting for cardiovascular risk factors gave similar effect sizes. In contrast, additional adjusting for smoking attenuated the effect sizes: HR, 1.09 (0.91-1.31) for all stroke; HR, 1.13 (0.91-1.42) for ischemic stroke; and HR 1.53 (0.91-2.59) for hemorrhagic stroke. After an acute severe exacerbation, subjects with COPD had a 6.66-fold (2.42-18.20) increased risk of stroke. CONCLUSIONS Our cohort study demonstrated a higher risk of both ischemic and hemorrhagic stroke in subjects with COPD and revealed the importance of smoking as a shared risk factor.
Collapse
Affiliation(s)
| | - Lies Lahousse
- 1 Department of Epidemiology.,3 Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Guy F Joos
- 3 Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Guy G Brusselle
- 1 Department of Epidemiology.,5 Department of Respiratory Medicine, and.,3 Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - M Arfan Ikram
- 1 Department of Epidemiology.,2 Department of Neurology.,6 Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; and
| |
Collapse
|
33
|
Muñoz-Esquerre M, López-Sánchez M, Escobar I, Huertas D, Penín R, Molina-Molina M, Manresa F, Dorca J, Santos S. Systemic and Pulmonary Vascular Remodelling in Chronic Obstructive Pulmonary Disease. PLoS One 2016; 11:e0152987. [PMID: 27046203 PMCID: PMC4821623 DOI: 10.1371/journal.pone.0152987] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/22/2016] [Indexed: 11/23/2022] Open
Abstract
Background Chronic Obstructive Pulmonary Disease (COPD) is associated with subclinical systemic atherosclerosis and pulmonary vascular remodelling characterized by intimal hyperplasia and luminal narrowing. We aimed to determine differences in the intimal thickening of systemic and pulmonary arteries in COPD subjects and smokers. Secondary aims include comparisons with a non-smokers group; determining the clinical variables associated with systemic and pulmonary intimal thickening, and the correlations between systemic and pulmonary remodelling changes. Methods All consecutive subjects undergoing lung resection were included and divided into 3 groups: 1) COPD, 2) smokers, and 3) non-smokers. Sections of the 5th intercostal artery and muscular pulmonary arteries were measured by histo-morphometry. Four parameters of intimal thickening were evaluated: 1) percentage of intimal area (%IA), 2) percentage of luminal narrowing, 3) intimal thickness index, and 4) intima-to-media ratio. Results In the adjusted analysis, the systemic arteries of COPD subjects showed greater intimal thickening (%IA) than those of smokers (15.6±1.5% vs. 14.2±1.6%, p = 0.038). In the pulmonary arteries, significant differences were observed for %IA between the 2 groups (37.3±2.2% vs. 29.3±2.3%, p = 0.016). Among clinical factors, metabolic syndrome, gender and COPD status were associated with the systemic intimal thickening, while only COPD status was associated with pulmonary intimal thickening. A correlation between the %IA of the systemic and pulmonary arteries was observed (Spearman’s rho = 0.46, p = 0.008). Conclusions Greater intimal thickening in systemic and pulmonary arteries is observed in COPD patients than in smokers. There is a correlation between systemic and pulmonary vascular remodelling in the overall population.
Collapse
Affiliation(s)
- Mariana Muñoz-Esquerre
- Department of Pulmonary Medicine, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Marta López-Sánchez
- Department of Pulmonary Medicine, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Ignacio Escobar
- Department of Thoracic Surgery, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Daniel Huertas
- Department of Pulmonary Medicine, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Rosa Penín
- Department of Pathology, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - María Molina-Molina
- Department of Pulmonary Medicine, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Networking Center Consortium -Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Frederic Manresa
- Department of Pulmonary Medicine, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Dorca
- Department of Pulmonary Medicine, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Salud Santos
- Department of Pulmonary Medicine, Bellvitge University Hospital -IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Biomedical Research Networking Center Consortium -Respiratory Diseases (CIBERES), Barcelona, Spain
- * E-mail:
| |
Collapse
|
34
|
Minhas SV, Goyal P, Patel AA. What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery? Clin Orthop Relat Res 2016; 474:611-8. [PMID: 26290342 PMCID: PMC4746182 DOI: 10.1007/s11999-015-4496-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/31/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Perioperative cerebrovascular accidents (CVAs) are one of the leading causes of patient morbidity, mortality, and medical costs. However, little is known regarding the rates of these events and risk factors for CVA after elective orthopaedic surgery. QUESTIONS/PURPOSES Our goals were to (1) establish the national, baseline proportion of patients experiencing a 30-day CVA and the timing of CVA; and (2) determine independent risk factors for 30-day CVA rates after common elective orthopaedic procedures. METHODS Patients undergoing elective TKA, THA, posterior or posterolateral lumbar fusion, anterior cervical discectomy and fusion, and total shoulder arthroplasty, from 2006 to 2012, were identified from the American College of Surgeons National Surgical Quality Improvement Program(®) database. A total of 42,150 patients met inclusion criteria. Thirty-day CVA rates were recorded for each procedure, and patients were assessed for characteristics associated with CVA through univariate analysis. Multivariate regression models were created to identify independent risk factors for CVA. RESULTS A total of 55 (0.13%) patients experienced a CVA within 30 days of the procedure, occurring a median of 2 days after surgery (range, 1-30 days) with 0.08% of patients experiencing a CVA after TKA, 0.15% after THA, 0.00% after single-level anterior cervical discectomy and fusion, 0.38% after multilevel anterior cervical discectomy and fusions, 0.20% after single-level posterior or posterolateral lumbar fusion, 0.70% after multilevel posterior or posterolateral lumbar fusion, and 0.22% after total shoulder arthroplasty. Independent risk factors for CVA included age of 75 years or older (odds ratio [OR], 2.50; 95% CI, 1.44-4.35; p = 0.001), insulin-dependent diabetes mellitus (OR, 3.08; CI, 1.47-6.45; p = 0.003), hypertension (OR, 2.71; CI, 1.19-6.13; p = 0.017), history of transient ischemic attack (OR, 2.83; CI, 1.24-6.45; p = 0.013), dyspnea (OR, 2.51; CI, 1.30-4.86; p = 0.006), chronic obstructive pulmonary disease (OR, 2.33; CI, 1.06-5.13; p = 0.036), and operative time of 180 minutes or greater (OR, 3.25; CI 1.60-6.60; p = 0.001). CONCLUSIONS Numerous nonmodifiable patient comorbidities and increased operative time were associated with CVA after elective orthopaedic procedures. However, the American College of Surgeons National Surgical Quality Improvement Program(®) database does not code for cardiac arrhythmia or atrial fibrillation, which other studies have suggested may be important predictor variables; those may be important risk factors, although we were unable to evaluate them in our study. Surgeons should counsel patients with these risk factors and limit their operative time to reduce the risk of these adverse events, and future studies should examine other patient characteristics such as arrhythmia and noncoronary heart disease and assess the role of pharmacologic prophylaxis in patients with these risk factors. LEVEL OF EVIDENCE Level III, prognostic study.
Collapse
Affiliation(s)
- Shobhit V Minhas
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU School of Medicine, New York, NY, USA
| | - Preeya Goyal
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alpesh A Patel
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair Street, NMH/Arkes Family Pavilion, Suite 1350, Chicago, IL, 60611, USA.
| |
Collapse
|
35
|
Alexandre F, Heraud N, Sanchez AM, Tremey E, Oliver N, Guerin P, Varray A. Brain Damage and Motor Cortex Impairment in Chronic Obstructive Pulmonary Disease: Implication of Nonrapid Eye Movement Sleep Desaturation. Sleep 2016; 39:327-35. [PMID: 26446126 PMCID: PMC4712404 DOI: 10.5665/sleep.5438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 09/05/2015] [Indexed: 12/14/2022] Open
Abstract
STUDY OBJECTIVES Nonrapid eye movement (NREM) sleep desaturation may cause neuronal damage due to the withdrawal of cerebrovascular reactivity. The current study (1) assessed the prevalence of NREM sleep desaturation in nonhypoxemic patients with chronic obstructive pulmonary disease (COPD) and (2) compared a biological marker of cerebral lesion and neuromuscular function in patients with and without NREM sleep desaturation. METHODS One hundred fifteen patients with COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] grades 2 and 3), resting PaO2 of 60-80 mmHg, aged between 40 and 80 y, and without sleep apnea (apnea-hypopnea index < 15) had polysomnographic sleep recordings. In addition, twenty-nine patients (substudy) were assessed i) for brain impairment by serum S100B (biological marker of cerebral lesion), and ii) for neuromuscular function via motor cortex activation and excitability and maximal voluntary quadriceps strength measurement. RESULTS A total of 51.3% patients (n = 59) had NREM sleep desaturation (NREMDes). Serum S100B was higher in the NREMDes patients of the substudy (n = 14): 45.1 [Q1: 37.7, Q3: 62.8] versus 32.9 [Q1: 25.7, Q3: 39.5] pg.ml(-1) (P = 0.028). Motor cortex activation and excitability were lower in NREMDes patients (both P = 0.03), but muscle strength was comparable between groups (P = 0.58). CONCLUSIONS Over half the nonhypoxemic COPD patients exhibited NREM sleep desaturation associated with higher values of the cerebral lesion biomarker and lower neural drive reaching the quadriceps during maximal voluntary contraction. The lack of muscle strength differences between groups suggests a compensatory mechanism(s). Altogether, the results are consistent with an involvement of NREM sleep desaturation in COPD brain impairment. CLINICAL TRIAL REGISTRATION The study was registered at www.clinicaltrials.gov as NCT01679782.
Collapse
Affiliation(s)
- Francois Alexandre
- Movement To Health Laboratory, Euromov, University of Montpellier, Montpellier, France
- Clinique du Souffle La Vallonie, Fontalvie, Lodève, France
| | - Nelly Heraud
- Clinique du Souffle La Vallonie, Fontalvie, Lodève, France
- Clinique du Souffle Les Clarines, Fontalvie, Riom-es-Montagnes, France
| | - Anthony M.J. Sanchez
- UMR866 Dynamique Musculaire et Métabolisme, INRA, University of Montpellier, Montpellier, France
- Laboratoire Performance Santé Altitude, EA 4604, University of Perpignan Via Domitia, Font-Romeu, France
| | - Emilie Tremey
- Clinique du Souffle La Vallonie, Fontalvie, Lodève, France
- Clinique du Souffle Les Clarines, Fontalvie, Riom-es-Montagnes, France
| | - Nicolas Oliver
- Clinique du Souffle La Vallonie, Fontalvie, Lodève, France
| | - Philippe Guerin
- Clinique du Souffle Les Clarines, Fontalvie, Riom-es-Montagnes, France
| | - Alain Varray
- Movement To Health Laboratory, Euromov, University of Montpellier, Montpellier, France
| |
Collapse
|
36
|
Leung JM, Sin DD. Chronic Obstructive Pulmonary Disease and Stroke. Strange Bedfellows. Am J Respir Crit Care Med 2016; 193:227-8. [DOI: 10.1164/rccm.201510-1977ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
37
|
Bagheri-Nesami M, Goudarzian AH, Mirani H, Jouybari SS, Nasiri D. ASSOCIATION BETWEEN SELF-CARE BEHAVIORS AND SELF-ESTEEM OF RURAL ELDERLIES; NECESSITY OF HEALTH PROMOTION. Mater Sociomed 2016; 28:41-5. [PMID: 27047266 PMCID: PMC4789745 DOI: 10.5455/msm.2016.28.41-45] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 01/05/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction: Changes in the modern medical science caused significant reduction of mortality and every day increase of the elderly in the world. According to prevalence of physical and mental problems in elderly, it is necessary to take some actions. Self care in one of the best way to improve elderly health and life satisfaction that seems have a relation to self-esteem. Methods: This descriptive and analytical study was performed on 180 elderly in rural areas of the Sari city. Elderly selected by multi-stage randomize sampling method. Data were gathered by using standard questionnaires of self-care and Rosenberg self-esteem. Data were analyzed by Spearman and Pearson’s correlation using SPSS software (V16). Findings: The mean±SD of the ages of the elderly were 66.85±7.661. The score of self-care varies between 99 to 155 and most of them (66.7%) had good level of self-care. Also, most of elderly (52.2%) had high level of self-esteem. Also there was a significant relationship, between self-care and self-esteem (P<0.001, r=0.426). Conclusion: According to significant relationship between self-care and self-esteem of elderly, by the planning for improving the self care of elderly, can increase their health and significantly reduce from physical and mental complications.
Collapse
Affiliation(s)
- Masoumeh Bagheri-Nesami
- Department of Medical- Surgical Nursing, Mazandaran Pediateric Infectious Disease Research Center (MPIDRC), Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Hesam Mirani
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Davoud Nasiri
- Department of Anatomy, Mazandaran University of Medical Sciences, Sari, Iran
| |
Collapse
|
38
|
The association of pulmonary function with carotid atherosclerosis in older Chinese: Guangzhou Biobank Cohort Study-CVD Subcohort. Atherosclerosis 2015; 243:469-76. [DOI: 10.1016/j.atherosclerosis.2015.09.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 11/19/2022]
|
39
|
Lindenmaier TJ, Kirby M, Paulin G, Mielniczuk L, Cunningham IA, Mura M, Licskai C, Parraga G. Pulmonary Artery Abnormalities in Ex-smokers with and without Airflow Obstruction. COPD 2015; 13:224-34. [DOI: 10.3109/15412555.2015.1074666] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
40
|
Bhavani S, Tsai CL, Perusich S, Hesselbacher S, Coxson H, Pandit L, Corry DB, Kheradmand F. Clinical and Immunological Factors in Emphysema Progression. Five-Year Prospective Longitudinal Exacerbation Study of Chronic Obstructive Pulmonary Disease (LES-COPD). Am J Respir Crit Care Med 2015; 192:1171-8. [PMID: 26241705 PMCID: PMC4731622 DOI: 10.1164/rccm.201504-0736oc] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/03/2015] [Indexed: 01/18/2023] Open
Abstract
RATIONALE Cross-sectional studies of T-cell responses to self-antigens correlate with baseline emphysema severity. OBJECTIVES We investigated whether clinical and/or immunological factors could predict disease progression, such as emphysema, FEV1, and 6-minute-walk distance (6MWD), in former and active smokers in a 5-year prospective study. METHODS We recruited 224 ever smokers over 40 years of age and with greater than a 15 pack-year smoking history. MEASUREMENTS AND MAIN RESULTS Repeated spirometry, 6MWD, and peripheral blood T-cell cytokine responses to lung elastin fragments were measured. Baseline and repeat chest computed tomography (CT) scans (34 to 65 mo apart) were used to quantify emphysema progression. Of the 141 ever-smokers with baseline and repeat CT scans, the mean (SD) annual rate of change in percent emphysema was +0.46 (0.92), ranging from -1.8 to +4.1. In multivariable analyses, the rate of emphysema progression was greater in subjects who had lower body mass index (BMI) (+0.15 per 5-unit decrease in BMI; 95% confidence interval, +0.03 to +0.29). In active smokers, increased IFN-γ and IL-6 T-cell responses had a positive association with the annual rate of emphysema progression. Male sex and IL-6 T-cell responses to elastin fragments were significantly associated with annual 6MWD decline, whereas IL-13 was associated with an increase in annual 6MWD. CONCLUSIONS The rate of emphysema progression quantified by CT scans among ever-smokers was highly variable; clinical factors and biomarkers explained only some of the variability. Aggressive clinical care that targets active smokers with autoreactive T cells and low BMI may temporize progression of emphysema.
Collapse
Affiliation(s)
| | - Chu-Lin Tsai
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Harvey Coxson
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Lavannya Pandit
- Department of Medicine
- Michael E. DeBakey Veterans Affairs Center for Translational Research on Inflammatory Diseases, Houston Texas
| | - David B. Corry
- Department of Medicine
- Department of Pathology and Immunology, and
- Biology of Inflammation Center, Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Center for Translational Research on Inflammatory Diseases, Houston Texas
| | - Farrah Kheradmand
- Department of Medicine
- Department of Pathology and Immunology, and
- Biology of Inflammation Center, Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Center for Translational Research on Inflammatory Diseases, Houston Texas
| |
Collapse
|
41
|
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over 1200 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
Collapse
|
42
|
Chen R, He W, Zhang K, Zheng H, Lin L, Nie R, Wang J, Huang H. Airflow obstruction was associated with elevation of brachial-ankle pulse wave velocity but not ankle-brachial index in aged patients with chronic obstructive pulmonary disease. Atherosclerosis 2015; 242:135-40. [DOI: 10.1016/j.atherosclerosis.2015.06.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/24/2015] [Accepted: 06/26/2015] [Indexed: 11/26/2022]
|
43
|
Lahousse L, Tiemeier H, Ikram MA, Brusselle GG. Chronic obstructive pulmonary disease and cerebrovascular disease: A comprehensive review. Respir Med 2015; 109:1371-80. [PMID: 26342840 DOI: 10.1016/j.rmed.2015.07.014] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 06/09/2015] [Accepted: 07/19/2015] [Indexed: 01/23/2023]
Abstract
Along with the aging population, the public health burden of cerebrovascular disease is increasing. Cerebral small vessel disease and accumulation of brain pathology associate with cognitive decline and can lead to clinical outcomes, such as stroke and dementia. Chronic Obstructive Pulmonary Disease (COPD) is a common respiratory disease among elderly. The quality of life and prognosis of patients with COPD is greatly determined by the presence of comorbidities including stroke and cognitive impairment. Despite the clinical relevance of cerebral small vessel disease, stroke and (vascular) cognitive impairment in patients with COPD, literature is scarce and underlying mechanisms are unknown. The aim of the present review is therefore to summarize current scientific knowledge, to provide a better understanding of the interplay between COPD and the aging brain and to define remaining knowledge gaps. This narrative review article 1) overviews the epidemiology of cerebral small vessel disease, stroke and cognitive impairment in patients with COPD; 2) discusses potential underlying mechanisms including aging, smoking, systemic inflammation, vasculopathy, hypoxia and genetic susceptibility; and 3) highlights areas requiring further research.
Collapse
Affiliation(s)
- Lies Lahousse
- Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium; Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands; Department of Psychiatry, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands; Department of Radiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands; Department of Neurology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium; Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands; Department of Respiratory Medicine, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| |
Collapse
|
44
|
Portillo K, Abad-Capa J, Ruiz-Manzano J. Enfermedad pulmonar obstructiva crónica y ventrículo izquierdo. Arch Bronconeumol 2015; 51:227-34. [DOI: 10.1016/j.arbres.2014.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/06/2014] [Accepted: 03/17/2014] [Indexed: 01/19/2023]
|
45
|
Chindhi S, Thakur S, Sarkar M, Negi PC. Subclinical atherosclerotic vascular disease in chronic obstructive pulmonary disease: Prospective hospital-based case control study. Lung India 2015; 32:137-41. [PMID: 25814798 PMCID: PMC4372867 DOI: 10.4103/0970-2113.152624] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is an important non-communicable disease worldwide with a rising global incidence. COPD is associated with multiple co-morbidities. Patients with COPD are at increased risk of atherosclerosis and other cardiovascular events. Cardiovascular diseases are an important cause of morbidity and mortality in COPD. The present case-control study was designed to assess the relationship between sub-clinical atherosclerotic vascular diseases with COPD. Methods: It was a prospective case-control blinded observational study. There were 142 COPD patients and 124 age-and sex-matched controls without COPD and cardiovascular diseases. Frequency of sub-clinical atherosclerosis was assessed by the carotid B-mode duplex ultrasonography assessment of carotid wall intima medial thickness (IMT). Plaque was defined as IMT of more than 1.2 mm. Results: Prevalence of carotid plaqing was significantly higher amongst patients of COPD (38.7%) compared to controls (13.7%, odds ratio 3.9, P < 0.0001). Multinomial logistic regression analysis revealed COPD as an independent predictor of carotid plaqing (r = 0.85, P < 0.023). Conclusion: The frequency of carotid plaqing is high in COPD patients. Carotid plaqing may be due to shared risk factors or the presence of low-grade systemic inflammation. Presence of increased CIMT and carotid plaqing in COPD patients identifies early atherosclerotic changes and future cardiovascular risk. Hence screening of CIMT should be a part of cardiovascular assessment in patients with COPD.
Collapse
Affiliation(s)
- Sandip Chindhi
- Department of General Medicine, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Surinder Thakur
- Department of Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Malay Sarkar
- Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Prakash C Negi
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| |
Collapse
|
46
|
Cung H, Aragon MJ, Zychowski K, Anderson JR, Nawarskas J, Roldan C, Sood A, Qualls C, Campen MJ. Characterization of a novel endothelial biosensor assay reveals increased cumulative serum inflammatory potential in stabilized coronary artery disease patients. J Transl Med 2015; 13:99. [PMID: 25890092 PMCID: PMC4376347 DOI: 10.1186/s12967-015-0457-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/10/2015] [Indexed: 11/10/2022] Open
Abstract
Background Vascular disease is promoted by systemic inflammation that can arise from sites distal to the affected vessels. We sought to characterize the net inflammatory potential of serum from patients with coronary artery disease (CAD) using cultured endothelial cells as a cumulative biosensor. Methods and results Serum samples from CAD patients (N = 45) and healthy control subjects (N = 48) were incubated with primary human coronary artery endothelial cells at a 1:10 dilution for 4 h, followed by isolation of the cellular RNA. Alteration of inflammation-responsive elements (adhesion molecules and cytokines) was assessed by gene expression. Specific indicators included intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and interleukin-8 (IL-8). Additionally, the cytokine levels in serum samples from all subjects were quantified. Serum from CAD subjects induced greater endothelial ICAM-1, VCAM-1, and IL-8 expression compared to healthy control serum (p < 0.001 for each analysis). The three indicators of inflammatory potential (ICAM-1, VCAM-1, and IL-8 mRNA) trended independently of each other and also of serum inflammatory biomarkers. IL-8 expression correlated negatively with serum HDL levels but positively correlated with VLDL, plasminogen activator inhibitor-1 and C-reactive protein. Interestingly, serum levels of cytokines in CAD patients were not statistically different from healthy control subjects. A year of follow-up in a sub-group of CAD subjects revealed relatively stable measures. Conclusions As yet unidentified circulating factors in the serum of CAD patients appear to activate endothelial cells, leading to upregulation of adhesion molecules and chemokines. This cumulative assay performed well in terms of discriminating patients with CAD compared to healthy subjects, with greater range and specificity than specific inflammatory markers.
Collapse
Affiliation(s)
- Heidi Cung
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA.
| | - Mario J Aragon
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA.
| | - Katherine Zychowski
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA.
| | - Joe R Anderson
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA.
| | - James Nawarskas
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA.
| | - Carlos Roldan
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA.
| | - Akshay Sood
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA.
| | - Clifford Qualls
- Department of Biostatistics, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
| | - Matthew J Campen
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA.
| |
Collapse
|
47
|
Lahousse L, Verlinden VJ, van der Geest JN, Joos GF, Hofman A, Stricker BH, Brusselle GG, Ikram MA. Gait patterns in COPD: the Rotterdam Study. Eur Respir J 2015; 46:88-95. [DOI: 10.1183/09031936.00213214] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 12/27/2014] [Indexed: 01/12/2023]
Abstract
Gait disturbances in patients with chronic obstructive pulmonary disease (COPD) may lead to disability and falls. As studies assessing gait kinematics in COPD are sparse, we investigated associations of COPD with various gait domains and explored a potential link with falling.Gait was measured within the prospective, population-based Rotterdam Study (age ≥55 years) using an electronic walkway and summarised into seven gait domains: Rhythm, Variability, Phases, Pace, Tandem, Turning and Base of Support. Rhythm is a temporal gait aspect that includes cadence and reflects how quickly steps are taken.Persons with COPD (n=196) exhibited worse Rhythm (−0.21 sd, 95% CI −0.36– −0.06 sd) compared with persons with normal lung function (n=898), independent of age, sex, height, education, smoking or analgesic use, especially when dyspnoea and severe airflow limitation or frequent exacerbations (Global Initiative for Chronic Obstructive Lung Disease group D: −0.83 sd, 95% CI −1.25– −0.41 sd) were present. A lower forced expiratory volume in 1 s was associated with worse Rhythm and Pace, including lower cadence and gait velocity, respectively. Importantly, fallers with COPD had significantly worse Rhythm than nonfallers with COPD.This study demonstrates that persons with COPD exhibit worse Rhythm, especially fallers with COPD. The degree of Rhythm deterioration was associated with the degree of airflow limitation, symptoms and frequency of exacerbations.
Collapse
|
48
|
Mooe T, Stenfors N. The Prevalence of COPD in Individuals with Acute Coronary Syndrome: A Spirometry-Based Screening Study. COPD 2014; 12:453-61. [DOI: 10.3109/15412555.2014.974742] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
49
|
Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J Chron Obstruct Pulmon Dis 2014; 9:871-88. [PMID: 25210449 PMCID: PMC4154888 DOI: 10.2147/copd.s49621] [Citation(s) in RCA: 236] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Comorbidities are frequent in chronic obstructive pulmonary disease (COPD) and significantly impact on patients’ quality of life, exacerbation frequency, and survival. There is increasing evidence that certain diseases occur in greater frequency amongst patients with COPD than in the general population, and that these comorbidities significantly impact on patient outcomes. Although the mechanisms are yet to be defined, many comorbidities likely result from the chronic inflammatory state that is present in COPD. Common problems in the clinical management of COPD include recognizing new comorbidities, determining the impact of comorbidities on patient symptoms, the concurrent treatment of COPD and comorbidities, and accurate prognostication. The majority of comorbidities in COPD should be treated according to usual practice, and specific COPD management is infrequently altered by the presence of comorbidities. Unfortunately, comorbidities are often under-recognized and under-treated. This review focuses on the epidemiology of ten major comorbidities in patients with COPD. Further, we emphasize the clinical impact upon prognosis and management considerations. This review will highlight the importance of comorbidity identification and management in the practice of caring for patients with COPD.
Collapse
Affiliation(s)
| | - Jeremy P Wrobel
- Advanced Lung Disease Unit, Royal Perth Hospital, Perth, WA, Australia
| |
Collapse
|
50
|
Barreiro E, Criner GJ. Update in chronic obstructive pulmonary disease 2013. Am J Respir Crit Care Med 2014; 189:1337-44. [PMID: 24881938 DOI: 10.1164/rccm.201402-0245up] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Esther Barreiro
- 1 Respiratory Medicine Department, Lung Cancer Research Group, Institute of Medical Research of Hospital del Mar, Hospital del Mar, Parc de Salut Mar, Barcelona Biomedical Research Park, Barcelona, Spain
| | | |
Collapse
|