Chest
Volume 145, Issue 4, April 2014, Pages 861-875
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Recent Advances in Chest Medicine
Arterial Stiffness in COPD

https://doi.org/10.1378/chest.13-1809Get rights and content

In patients with COPD, cardiovascular diseases are the most common concomitant chronic diseases, a leading cause of hospitalization, and one of the main causes of death. A close connection exists between COPD and cardiovascular diseases. Cardiovascular risk scores aim to predict the effect of cardiovascular comorbidities on COPD mortality, but there is a need to better characterize occult and suboccult cardiovascular disease, even in patients with mild to moderate COPD. Among various surrogate markers of cardiovascular risk, arterial stiffness plays a central role and is a strong independent predictor of cardiovascular events beyond classic cardiovascular risk factors. Its measurement is highly suitable, validated, and relatively easy to perform in routine COPD clinical practice. The growing awareness of the increased cardiovascular risk associated with COPD has led to a call for respiratory physicians to measure arterial pulse wave velocity in routine practice. Cross-sectional data establish elevated arterial stiffness as being independently linked to COPD. Candidate mechanisms have been proposed, but surprisingly, only limited data are available regarding the impact of the different COPD treatment modalities on arterial stiffness, although initial studies have suggested a significant positive impact. In this review, we present the various surrogate markers of cardiovascular morbidity in COPD and the central role of arterial stiffness and the underlying mechanisms explaining vascular remodeling in COPD. We also consider the therapeutic impact of COPD medications and exercise training on arterial stiffness and the assessments that should be implemented in COPD care and follow-up.

Section snippets

Surrogate Markers of Cardiovascular Morbidity in COPD

Because cardiovascular risk scores may underestimate the risk of cardiovascular events, particularly in early prevention, and sophisticated combinations of biomarkers fail to improve the prediction of cardiovascular outcomes,24 several studies have investigated subclinical markers of cardiovascular risk in smokers and the COPD population. Among these, noninvasive measurements of carotid intima-media thickness, reflecting early atherosclerosis; modifications in endothelial function; and arterial

Mechanisms of Elevated Arterial Stiffness in COPD

Mechanisms leading to arterial stiffness have been extensively reviewed in the general cardiovascular literature,16, 53, 65, 66 for chronic conditions such as kidney disease and metabolic diseases, and in sleep apnea syndrome.65, 67, 68, 69 The main contributing factors consistently reported for arterial stiffness are aging, BP, metabolic disorders, chronic inflammation, and oxidative stress. Arteries (and more specifically, central arteries) stiffen with aging because of a degeneration of the

Do Therapeutic Interventions in COPD Have an Impact on Arterial Stiffness? Current Literature and Future Research Directions

To our knowledge, only four studies evaluated the effects of inhaled therapies or exercise training programs on arterial stiffness in COPD (Fig 3, Table 2). Furthermore, only one additional study investigated the acute effect of oxygen supplementation on arterial stiffness in COPD.90

Clinical Impact and Perspectives

A large number of studies addressing arterial stiffness in COPD support the use of PWV for arterial stiffness measurements in clinical practice and as an objective and reproducible outcome for clinical trials. The recent consensus document published by the cardiology community on PWV measurements and reference values may help clinicians to standardize measurements and detect patients with abnormal values. Smoking and airflow limitation; systemic inflammation and hypoxia (that are amplified in

Acknowledgments

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.

Other contributions: The manuscript was critically edited by Alison Foote, PhD, with particular attention to English usage.

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    Funding/Support: This work was supported by grants from the scientific council of AGIRàdom.

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