John Michelle, McKeever Tricia M, Haddad Maath Al, Hall Ian P, Sayers Ian, Cockcroft John R, Bolton Charlotte E
Nottingham Respiratory Research Unit and Division of Respiratory Medicine, School of Medicine, University of Nottingham, Nottingham, UK.
Department of Epidemiology, School of Medicine, University of Nottingham, Nottingham, UK.
Chron Respir Dis. 2016 Aug;13(3):247-55. doi: 10.1177/1479972316636995. Epub 2016 Mar 10.
With the increased cardiovascular (CV) morbidity and mortality in subjects with chronic obstructive pulmonary disease (COPD), there is a priority to identify those patients at increased risk of cardiovascular disease. Stable patients with COPD (n = 185) and controls with a smoking history (n = 106) underwent aortic pulse wave velocity (PWV), blood pressure (BP) and skin autofluorescence (AF) at clinical stability. Blood was sent for fasting lipids, soluble receptor for advanced glycation end products (sRAGE) and CV risk prediction scores were calculated. More patients (18%) had a self-reported history of CV disease than controls (8%), p = 0.02, whilst diabetes was similar (14% and 10%), p = 0.44. Mean (SD) skin AF was greater in patients: 3.1 (0.5) AU than controls 2.8 (0.6) AU, p < 0.001. Aortic PWV was greater in patients: 10.2 (2.3) m/s than controls: 9.6 (2.0) m/s, p = 0.02 despite similar BP. The CV risk prediction scores did not differentiate between patients and controls nor were the individual components of the scores different. The sRAGE levels were not statistically different. We present different indicators of CV risk alongside each other in well-defined subjects with and without COPD. Two non-invasive biomarkers associated with future CV burden: skin AF and aortic PWV are both significantly greater in patients with COPD compared to the controls. The traditional CV prediction scores used in the general population were not statistically different. We provide new data to suggest that alternative approaches for optimal CV risk detection should be employed in COPD management.
鉴于慢性阻塞性肺疾病（COPD）患者心血管（CV）发病率和死亡率增加，识别那些心血管疾病风险增加的患者成为当务之急。稳定期COPD患者（n = 185）和有吸烟史的对照组（n = 106）在临床稳定期接受了主动脉脉搏波速度（PWV）、血压（BP）和皮肤自发荧光（AF）检测。采集血液检测空腹血脂、晚期糖基化终产物可溶性受体（sRAGE），并计算CV风险预测评分。有自我报告心血管疾病史的患者（18%）多于对照组（8%），p = 0.02，而糖尿病患病率相似（分别为14%和10%），p = 0.44。患者的平均（标准差）皮肤AF更高：3.1（0.5）任意单位，高于对照组的2.8（0.6）任意单位，p < 0.001。尽管血压相似，但患者的主动脉PWV更高：10.2（2.3）m/s，高于对照组的9.6（2.0）m/s，p = 0.02。CV风险预测评分在患者和对照组之间没有差异，评分的各个组成部分也没有差异。sRAGE水平无统计学差异。我们在明确界定的有和没有COPD的受试者中同时展示了不同的CV风险指标。与未来CV负担相关的两种非侵入性生物标志物：皮肤AF和主动脉PWV在COPD患者中均显著高于对照组。一般人群中使用的传统CV预测评分无统计学差异。我们提供了新的数据，表明在COPD管理中应采用替代方法进行最佳CV风险检测。
