Lower extremity and carotid artery disease in COPD

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.

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

“…The same, i.e. a high frequency of LEAD in COPD patients (80.4%), was also demonstrated by Pizzaro et al, [18]. On the other side, Watz et al demonstrated a lower frequency of LEAD in COPD patients (25.3%) [35].…”

“…Vascular changes are one of the cardiovascular complications of COPD, probably due to the chronic, low-grade, systemic inflammation that leads to atherosclerosis in carotid and other arteries [29]. The inflammatory cascade that initially arises from exposure to noxious substances, mainly tobacco smoke, accelerates atherogenesis at all stages by formation, destabilisation and rupture of plaque as well as by platelet activation and clotting that lead to atheroma formation and atherothrombosis [18]. Nevertheless, the association between COPD and vascular comorbidities, i.e.…”

“…Lyn et al reported the prevalence of asymptomatic PAD in Taiwan of 8.4%, Pecci in a Hispanic study of 36.8%, Pizzaro in a German study of 80% and Castagna in a French study of 81%. The common conclusion in all these studies is that patients with COPD and PAD, have worse pulmonary function [14], [15], [16], [17], [18], [19].…”

Coronary lesions in patients with COPD (Global Initiative for Obstructive Lung Disease stages I&ndash;III) and suspected or confirmed coronary arterial disease

“…The frequent occurrence of stenosis, severe lesions, and markedly calcified coronary plaques, especially in the GOLD III group (even with the small sample), was another finding of this study and reinforces the conclusion that the inflammatory processes of COPD do not participate only in the formation of atherosclerotic plaques but also in their progression. 30 – 32 …”

High risk of subclinical atherosclerosis in COPD exacerbator phenotype

“…Smoking and diabetes are the two main risk factors for peripheral arterial disease. Therefore, it is not surprising that a 22% of our participants had peripheral arterial disease, presenting an ABI < 0.9, an association with COPD that has been reported as between 8.5% [41] and 41% [42]; nevertheless, we found no differences between the exacerbator and non-exacerbator groups.…”