From the Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, United Kingdom (M.F., C.M.M., K.M.-P., J.W.-S., J.C., I.B.W.); School of Healthcare Sciences (N.G.) and Department of Cardiology, Wales Heart Research Institute (M.M., J.R.C.), Cardiff University, United Kingdom; Cambridge Clinical Trials Unit (J.R.F., J.C., I.B.W.) and Division of Respiratory Medicine (J.F.), Cambridge University Hospitals NHS Foundation Trust, United Kingdom; GSK R&D, King of Prussia, PA (D.M., R.T.S.); and NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, United Kingdom (D.M., M.I.P.).
Hypertension. 2018 Mar;71(3):499-506. doi: 10.1161/HYPERTENSIONAHA.117.10151. Epub 2018 Jan 22.
Cardiovascular disease is a common comorbidity and cause of mortality in chronic obstructive pulmonary disease. A better understanding of mechanisms of cardiovascular risk in chronic obstructive pulmonary disease patients is needed to improve clinical outcomes. We hypothesized that such patients have increased arterial stiffness, wave reflections, and subclinical atherosclerosis compared with controls and that these findings would be independent of smoking status and other confounding factors. A total of 458 patients with a diagnosis of chronic obstructive pulmonary disease and 1657 controls (43% were current or ex-smokers) with no airflow limitation were matched for age, sex, and body mass index. All individuals underwent assessments of carotid-femoral (aortic) pulse wave velocity, augmentation index, and carotid intima-media thickness. The mean age of the cohort was 67±8 years and 58% were men. Patients with chronic obstructive pulmonary disease had increased aortic pulse wave velocity (9.95±2.54 versus 9.27±2.41 m/s; <0.001), augmentation index (28±10% versus 25±10%; <0.001), and carotid intima-media thickness (0.83±0.19 versus 0.74±0.14 mm; <0.001) compared with controls. Chronic obstructive pulmonary disease was associated with increased levels of each vascular biomarker independently of physiological confounders, smoking, and other cardiovascular risk factors. In this large case-controlled study, chronic obstructive pulmonary disease was associated with increased arterial stiffness, wave reflections, and subclinical atherosclerosis, independently of traditional cardiovascular risk factors. These findings suggest that the cardiovascular burden observed in this condition may be mediated through these mechanisms and supports the concept that chronic obstructive pulmonary disease is an independent risk factor for cardiovascular disease.
心血管疾病是慢性阻塞性肺疾病的常见合并症和死亡原因。为了改善临床结局，我们需要更好地了解慢性阻塞性肺疾病患者心血管风险的机制。我们假设，与对照组相比，这些患者的动脉僵硬度、波反射和亚临床动脉粥样硬化增加，并且这些发现与吸烟状况和其他混杂因素无关。共有 458 例慢性阻塞性肺疾病患者和 1657 例无气流限制的对照组（43%为现吸烟者或曾吸烟者）与年龄、性别和体重指数相匹配。所有个体均接受了颈动脉-股动脉（主动脉）脉搏波速度、增强指数和颈动脉内膜中层厚度的评估。队列的平均年龄为 67±8 岁，58%为男性。与对照组相比，慢性阻塞性肺疾病患者的主动脉脉搏波速度（9.95±2.54 对 9.27±2.41 m/s；<0.001）、增强指数（28±10%对 25±10%；<0.001）和颈动脉内膜中层厚度（0.83±0.19 对 0.74±0.14 mm；<0.001）更高。慢性阻塞性肺疾病与每个血管生物标志物的水平升高独立于生理混杂因素、吸烟和其他心血管危险因素相关。在这项大型病例对照研究中，慢性阻塞性肺疾病与动脉僵硬度、波反射和亚临床动脉粥样硬化的增加独立相关，而与传统心血管危险因素无关。这些发现表明，在这种情况下观察到的心血管负担可能通过这些机制介导，并支持慢性阻塞性肺疾病是心血管疾病的独立危险因素的概念。
