Carotid Artery Disease and Lower Extremities Artery Disease in Patients with Chronic Obstructive Pulmonary Disease

Abstract

AIM: To assess the frequency of carotid artery disease (CAD) and lower extremities artery disease (LEAD) in patients with chronic obstructive pulmonary disease (COPD) and their relation to the severity of airflow limitation and the level of C-reactive protein (CRP).
 METHODS: We performed a cross-sectional study including 60 patients with COPD (52 male, 8 female), aged 40 to 80 years, initially diagnosed according to the actual criteria. Also, 30 subjects in whom COPD was excluded, matched to COPD patients by sex, age, body mass index and smoking status, served as controls. All study subjects completed questionnaire and underwent pulmonary evaluation (dyspnea severity assessment, baseline and post-bronchodilator spirometry, gas analyses, and chest X-ray), angiological evaluation by Doppler ultrasonography and measurement of serum CRP level.
 RESULTS: We found a statistically significant difference between the frequency of carotid plaques in COPD patients as compared to their frequency in controls (65% vs 30%; P = 0.002). The mean value of intima-media thickness (IMT) in COPD patients with CAD was significantly higher than its mean value in controls (0.8 ± 0.2 vs. 0.7 ± 0.2; P = 0.049). IMT value in COPD patients with CAD was significantly related to the degree of airflow limitation, i.e. to the degree of FEV1 decline (P = 0.000), as well as to the serum CRP level (P = 0.001). We found a statistically significant difference between the frequency of COPD patients with LEAD as compared to the frequency of LEAD in controls (78.3% vs 43.3%; P = 0.001). According to the Fontaine classification, COPD patients with LEAD were categorized in the stages I, IIA and IIB (53.3%, 30% and 16.7%, respectively), whereas all controls with LEAD were categorized in the Fontaine stage I. Among COPD patients with LEAD there was significant association between disease severity and clinical manifestations due to the vascular changes (P = 0.001) and serum CRP level (P = 0.001).
 CONCLUSION: Our findings suggest higher prevalence and higher severity of vascular changes in COPD patients as compared to their prevalence and severity in non-COPD subjects. Prevalence and severity of vascular changes in COPD patients were significantly related to the severity of airflow limitation and serum CRP levels.

Markers of Carotid Plaque Destabilization in Patients With Sleep-Disordered Breathing

“…The patients with non-SDB included 6 women and 5 men while the SDB group consisted of 12 men and 2 women. Although not statistically significant, the prevalence of women with plaques in the SDB group was lower than in men as previously described ( 30 , 31 ).…”

“…Additionally, the association between carotid plaques and COPD was previously documented. Bukliosaka-Ilievska et al ( 30 ) reported that 65% of patients with COPD had carotid plaques, and in a meta-analysis conducted by Ambrosino et al, COPD was significantly associated with subclinical atherosclerosis, particularly with a significantly thicker carotid IMT. Moreover, the prevalence of plaques was two times as high as compared with non-COPD controls, making COPD by itself a risk factor for the development of carotid plaques ( 31 ), likely due to the sustained hypoxia they experience.…”

Cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: echocardiography changes and their relation to the level of airflow limitation

“…Frequency and severity of echocardiographic changes registered by 2D Doppler echocardiography in initially diagnosed COPD patients and non-COPD controls were compared in cross-sectional analysis. The study was conducted at the General Hospital "8th September", Skopje, in the period January -May 2018 as a continuum of our investigation of the impact of cardiovascular comorbidities on COPD (19). The study was approved by the Ethics Committee of the Medical Faculty at University "Sts.Cyril and Methodius", Skopje (03-2237/5/21.05.2018) [19].…”

“…The study was conducted at the General Hospital "8th September", Skopje, in the period January -May 2018 as a continuum of our investigation of the impact of cardiovascular comorbidities on COPD (19). The study was approved by the Ethics Committee of the Medical Faculty at University "Sts.Cyril and Methodius", Skopje (03-2237/5/21.05.2018) [19].…”

“…Inclusion and exclusion criteria for Group 1 and Group 2 are explained in our article on carotid artery disease, and lower extremities artery disease in patients with COPD published previously [19].…”