Purpose: The mechanisms underlying pathogenetic interactions between chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) are largely unknown despite a clinical mutual association in causing mortality and morbidity. Besides smoking, obesity and systemic inflammation share the complicity of being causative factors for both CVD and COPD. The present study aims to investigate, in an unselected, community-dwelling, elderly population, possible relationships between lung and cardiovascular impairements. Methods: A screening questionnaire was administered to 500 subjects aged from 65 to 84 years, randomly selected from the general population of Verona. All consenting participants underwent conventional pulmonary function test and diagnostic cardiovascular study (Echocardiografy, carotid Echo-Color-Doppler and Ankle-Brachial-Index). Blood pressure (BP), body mass index (BMI) and biochemical metabolic blood data were routinely obtained from all the participants. Results: COPD vs not-COPD patients differ for age (mean age: 70 vs 67 ys) but not for BP (mean: 130/80 vs 130/82 mmHg), BMI (mean: 28 vs 27 g/m2), total cholesterol (mean: 192 vs 220 mg/dL) and glycaemia (mean: 102 vs 97 mg/dL). In COPD patient forced expiratory volume in the first second (FEV1) was linearly related to reductions in left ventricular end-diastolic volume (p<0.05) and stroke volume (p<0.05) but not with ejection fraction. Left ventricular mass is related to pO2 value (p<0.001). COPD patients related to control patients present: pathological Intima-Media-Thickness (mean: 0.12 vs 0.08 cm, p<0.001) and ABI (mean: 0.87 vs 1.05, p<0.001), a grater extension of atherosclerotic burden (mean number of carotid plague: 2.5 vs 1.2) and higher level of plaque calcification. Conclusions: Magnitude of changes in the cardiac structure and function is related to the severity of COPD. COPD patients show a great prevalence of peripheral vasculopathy and a typical pattern of cardiac and vascular remodelling that expose them to high cardiovascular risk. In particular the mechanical reduction of cardiac outflow linked to hyperinflation state, vascular tone regulation and stiffness due to O2 blood pressure variation and the great atherosclerotic tendency have to be taken into account in the evaluation of COPD patients.
Cardiovascular function and comorbidities in elderly subjects with COPD
VALLERIO, Paola;FERRARI, Marcello;Rainer, Silvia;FRATTA PASINI, Anna Maria;COMINACINI, Luciano
2013-01-01
Abstract
Purpose: The mechanisms underlying pathogenetic interactions between chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) are largely unknown despite a clinical mutual association in causing mortality and morbidity. Besides smoking, obesity and systemic inflammation share the complicity of being causative factors for both CVD and COPD. The present study aims to investigate, in an unselected, community-dwelling, elderly population, possible relationships between lung and cardiovascular impairements. Methods: A screening questionnaire was administered to 500 subjects aged from 65 to 84 years, randomly selected from the general population of Verona. All consenting participants underwent conventional pulmonary function test and diagnostic cardiovascular study (Echocardiografy, carotid Echo-Color-Doppler and Ankle-Brachial-Index). Blood pressure (BP), body mass index (BMI) and biochemical metabolic blood data were routinely obtained from all the participants. Results: COPD vs not-COPD patients differ for age (mean age: 70 vs 67 ys) but not for BP (mean: 130/80 vs 130/82 mmHg), BMI (mean: 28 vs 27 g/m2), total cholesterol (mean: 192 vs 220 mg/dL) and glycaemia (mean: 102 vs 97 mg/dL). In COPD patient forced expiratory volume in the first second (FEV1) was linearly related to reductions in left ventricular end-diastolic volume (p<0.05) and stroke volume (p<0.05) but not with ejection fraction. Left ventricular mass is related to pO2 value (p<0.001). COPD patients related to control patients present: pathological Intima-Media-Thickness (mean: 0.12 vs 0.08 cm, p<0.001) and ABI (mean: 0.87 vs 1.05, p<0.001), a grater extension of atherosclerotic burden (mean number of carotid plague: 2.5 vs 1.2) and higher level of plaque calcification. Conclusions: Magnitude of changes in the cardiac structure and function is related to the severity of COPD. COPD patients show a great prevalence of peripheral vasculopathy and a typical pattern of cardiac and vascular remodelling that expose them to high cardiovascular risk. In particular the mechanical reduction of cardiac outflow linked to hyperinflation state, vascular tone regulation and stiffness due to O2 blood pressure variation and the great atherosclerotic tendency have to be taken into account in the evaluation of COPD patients.
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