Traditional and emerging indicators of cardiovascular risk in chronic obstructive pulmonary disease

Abstract

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.

Receptor for advanced glycation end-products and environmental exposure related obstructive airways disease: a systematic review

“…The cardiovascular risk prediction scores and sRAGE levels were the same in both groups. They found no associations between sRAGE and diabetes or aortic pulse wave velocity [44]. In the absence of ischaemic heart disease or diabetes, COPD patients had significantly lower levels of sRAGE, which is consistent with prior literature.…”

“…The results of studies assessing sRAGE and cardiovascular disease are heterogeneous. One study looked specifically at COPD patients and non-COPD smokers with calculated cardiovascular risk prediction scores [44]. The cardiovascular risk prediction scores and sRAGE levels were the same in both groups.…”

Measures of lung function and their relationship with advanced glycation end-products

“…Plasma AGEs and SAF are thought to be increased in patients with chronic obstructive pulmonary disease (COPD) [12][13][14][15]. This relationship has been present independently of smoking, DM, CVD or renal disease [13].…”

Systemic vascular dysfunction is associated with emphysema burden in mild COPD

“…Interestingly, several lines of evidence have recently uncovered a hitherto unknown link between emphysema extension and cardiovascular disease beginning during the earlier stages of COPD, i.e., patients with preserved FEV 1 (Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric grade 1) [9][10][11]. The prevailing view is that repeated COPD exacerbations are associated with chronic pro-inflammatory [12] and hyper-oxidative stresses [13] which can impair systemic vascular function [14][15][16], as indicated by higher aortic stiffness [17] and impaired flow-mediated vasodilatation [18]. Due to either ensuing cardiovascular co-morbidities [19] or a chronic sedentary life style [20], these patients present with higher effort-related dyspnea (GOLD 2017 clinical group B) [16].…”