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Systemic vascular dysfunction is associated with emphysema burden in mild COPD

Joel T Zelt1, Joshua H Jones1, Daniel M Hirai1

  • 1Laboratory of Clinical Exercise Physiology (LACEP), Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, Kingston, Canada.

Respiratory Medicine
|March 5, 2018
PubMed

Insights

Systemic vascular dysfunction is evident in early COPD, even in low-risk patients. Greater emphysema and reduced lung function correlate with poorer vascular health, suggesting a need for closer cardiovascular monitoring.

Area of Science:

  • Pulmonary Medicine
  • Cardiovascular Medicine
  • Vascular Biology

Background:

  • Cardiovascular diseases contribute significantly to morbidity and mortality in early stages of Chronic Obstructive Pulmonary Disease (COPD).
  • Systemic vascular dysfunction is hypothesized to exist even in patients considered low-risk for cardiovascular outcomes (GOLD spirometric grade 1, clinical group A).

Purpose of the Study:

  • To investigate the presence of systemic vascular dysfunction in patients with early-stage COPD.
  • To determine the relationship between COPD-related structural lung changes (emphysema, airway disease) and vascular abnormalities.

Main Methods:

  • 16 early-stage COPD patients and 16 controls underwent measurements of central arterial stiffness (pulse wave velocity), brachial flow-mediated dilation, and forearm muscle oxygenation (near-infrared spectroscopy).
  • Computed tomography was used to quantify emphysema (percentage of low attenuation areas - LAA) and airway disease.
  • Transfer factor for carbon monoxide (TLCO) was measured.

Main Results:

  • COPD patients exhibited higher central arterial stiffness, lower normalized flow-mediated dilation, delayed dilation time, and poorer muscle oxygenation compared to controls (p < 0.05).
  • Emphysema extent (LAA) was negatively related to TLCO (r = -0.63; p = 0.01).
  • TLCO and emphysema, but not airway disease, were significantly associated with the observed vascular and muscle oxygenation abnormalities (r values 0.51–0.66; p < 0.05).

Conclusions:

  • Systemic vascular dysfunction is present in early COPD, particularly in patients with higher emphysema burden and lower TLCO.
  • These vascular and functional abnormalities, regardless of FEV1, may indicate a higher risk for adverse cardiovascular events.
  • Patients with these findings warrant closer follow-up for early cardiovascular disease detection.
Abstract

Keywords:
Blood flowComputed tomographyEmphysemaGas exchangeVascular function

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