Analysis of Risk Factors for Carotid Atherosclerotic Stenosis in Senior Chronic Obstructive Pulmonary Disease Patients_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

GuoLu ¹ , GongShuai ² , LiuYuejian ¹ , WangZhengyang ³ ,  XieZhengliang ¹

1. Department of Respiratory Medicine, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, University Hospital of Electronic Science and Technology of China, Chengdu, Sichuan, 610072, China;
2. ;
3. ;

Corresponding author：

XieZhengliang, Email: 704827217@qq.com

Keywords：

Chronic obstructive pulmonary disease; Atherosclerosis; Stenosis; Risk factor

DOI：

10.7507/1671-6205.2016056

Video：

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Objective To observe the frequency and severity of carotid atherosclerotic stenosis in senior chronic obstructive pulmonary disease (COPD) patients and explore the related risk factors in order to provide a theoretical basis for the effective prevention of cardiovascular comorbidity in COPD. Methods Stable COPD out-patients followed up in Sichuan Provincial People's Hospital were prospectively enrolled between August 2012 and August 2015, who had carotid atherosclerosis confirmed by cervical vascular color ultrasonic inspection within 3 months. All the patients were divided into a carotid stenosis group and a non-carotid stenosis group. Demographic and laboratory data were extracted and compared between two groups. Pearson correlation and Logistic regression analysis were performed to analyze the risk factors related to carotid stenosis. Results Of 380 consecutive senior patients with COPD and carotid atherosclerosis, 199 (52.37%) had carotid stenosis. Compared with those without carotid stenosis, the patients in the carotid stenosis group had significantly higher levels of hypersensitive C reactive protein (hs-CRP), uric acid (UA), brain natriuretic peptide (BNP) and smoking index (P < 0.05). Lower levels of forced expiratory volume in one second (FEV₁%) and body mass index (BMI) were also observed in the carotid stenosis group (P < 0.05). Pearson correlation and logistic regression analysis showed that hs-CRP (OR 1.040, 95%CI 1.011-3.070), UA (OR 1.003, 95%CI 1.000-2.006), FEV₁ (OR 0.899, 95%CI 0.200-5.722), smoking index (OR 1.002, 95%CI 1.001-2.904) and BMI (OR 0.955, 95%CI 0.312-4.866) were associated with carotid stenosis. Conclusions Carotid atherosclerotic stenosis is common in senior COPD patients. Higher levels of hs-CRP, UA and smoking index and lower levels of FEV₁ and BMI may be independent risk factors for carotid stenosis in COPD.

Citation： Guo Lu, Gong Shuai, Liu Yuejian, Wang Zhengyang, Xie Zhengliang. Analysis of Risk Factors for Carotid Atherosclerotic Stenosis in Senior Chronic Obstructive Pulmonary Disease Patients. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(3): 236-240. doi: 10.7507/1671-6205.2016056 Copy

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3.	Patel AR, Kowlessar BS, Donaldson GC, et al. Cardiovascular risk, myocardial injury, and exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2013, 188:1091-1099.
4.	Alfageme I, Reyes N, Merino M, et al. The effect of airflow limitation on the cause of death in patients with COPD. Chron Respir Dis, 2010, 7:135-145.
5.	Su TC, Chien KL, Jeng JS, et al. Age-and gender-associated determinants of carotid intima-media thickness: a community-based study. J Atheroscler Thromb, 2012, 19:872-880.
6.	Drohomirecka A, Ko towski L, Kwinecki P, et al. Risk factors for carotid artery disease in patients scheduled for coronary artery bypass grafting. Kardiol Pol, 2010, 68:789-794.
7.	Karoli NA, Dolishniaia GR, Rebrov AP. Arterial rigidity in patients with chronic obstructive pulmonary disease. Klin Med (Mosk), 2012, 90:38-42.
8.	郭璐, 解郑良, 刘跃建, 等.慢性阻塞性肺疾病患者合并动脉粥样硬化的危险因素研究.中国呼吸与危重监护杂志, 2011, 10:376-379.
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11.	Grant EG, Benson CB, Moneta GL, et al. Carotid artery stenosis: gray-scale and Doppler US diagnosis--Society of Radiologists in Ultrasound Consensus Conference. Radiology, 2003, 229:340-346.
12.	周永昌, 郭万学, 主编.超声医学.第4版.北京:科学技术文献出版社, 2006, 717.
13.	Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J, 2005, 26: 319-338.
14.	Topsakal R, Kalay N, Ozdogru I, et al. Effects of chronic obstructive pulmonary disease on coronary atherosclerosis. Heart Vessels, 2009, 24:164-168.
15.	Komnata K. The influence of inflammatory process on the ventilatory impairment in patients with stable chronic obstructive pulmonary disease. Pneumonol Alergol Pol, 2010, 78:271-278.
16.	Polikutina OM, Slepynina YS, Bazdyrev ED, et al. Rate of detection of atherosclerosis in patients with ST elevation myocardial infarction and concomitant chronic obstructive pulmonary disease of light or moderate degree of severity. Kardiologiia, 2015, 55:26-31.
17.	Fox IH. Metabolic basis for disorders of purine nucleotide degradation. Metabolism, 1981, 30:616-634.
18.	Elsayed NM, Nakashima JM, Postlethwait EM. Measurement of uric acid as a marker of oxygen tension in the lung. Arch Biochem Biophys, 1993, 302:228-232.
19.	Ruggiero C, Cherubini A, Ble A, et al. Uric acid and inflammatory markers. Eur Heart J, 2006, 27:1174-1181.
20.	Bartziokas K, Papaioannou AI, Loukides S, et al. Serum uric acid as a predictor of mortality and future exacerbations of COPD. Eur Respir J, 2014, 43:43-53.
21.	Pascual-Figal DA, Hurtado-Martínez JA, Redondo B, et al. Hyperuricaemia and long-term outcome after hospital discharge in acute heart failure patients. Eur J Heart Fail, 2007, 9:518-524.
22.	Rubinsztajn R, Przyby owski T, Karwat K, et al. Patients with chronic obstructive pulmonary disease (COPD)-similarities and differences of the study group participating in the project of National Center for Research and Development project "Chronic obstructive pulmonary disease (COPD)-systemic disease, the biggest threat of XXI century". Pol Merkur Lekarski, 2015, 39:359-363.
23.	Enright PL. Smoking, lung function, and atherosclerosis in the 5, 000 elderly participants of the cardiovascular health study. Am J Geriatr Cardiol, 1994, 3:35-38.
24.	Tabara Y, Muro S, Takahashi Y, et al. Airflow limitation in smokers is associated with arterial stiffness: the Nagahama Study. Atherosclerosis, 2014, 232:59-64.
25.	Pan J, Xu L, Cai SX, et al. The association of pulmonary function with carotid atherosclerosis in older Chinese: Guangzhou Biobank Cohort Study-CVD Subcohort. Atherosclerosis, 2015, 243:469-476.
26.	Engstr m G, Hedblad B, Valind S, et al. Asymptomatic leg and carotid atherosclerosis in smokers is related to degree of ventilatory capacity: longitudinal and cross-sectional results from 'Men born in 1914', Sweden. Atherosclerosis, 2001, 155:237-243.
27.	Galal W, van Domburg RT, Feringa HH, et al. Relation of body mass index to outcome in patients with known or suspected coronary artery disease. Am J Cardiol, 2007, 99:1485-1490.
28.	Blum A, Simsolo C, Sirchan R, et al. "Obesity paradox" in chronic obstructive pulmonary disease. Isr Med Assoc J, 2011, 13:672-675.

1. Man SF, Leipsic JA, Man JP, et al. Is atherosclerotic heart disease in COPD a distinct phenotype? Chest, 2011, 140:569-571.
2. Vestbo J, Anderson J, Brook RD, et al. The Study to Understand Mortality and Morbidity in COPD (SUMMIT) study protocol. Eur Respir J, 2013, 41:1017-1022.
3. Patel AR, Kowlessar BS, Donaldson GC, et al. Cardiovascular risk, myocardial injury, and exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2013, 188:1091-1099.
4. Alfageme I, Reyes N, Merino M, et al. The effect of airflow limitation on the cause of death in patients with COPD. Chron Respir Dis, 2010, 7:135-145.
5. Su TC, Chien KL, Jeng JS, et al. Age-and gender-associated determinants of carotid intima-media thickness: a community-based study. J Atheroscler Thromb, 2012, 19:872-880.
6. Drohomirecka A, Ko towski L, Kwinecki P, et al. Risk factors for carotid artery disease in patients scheduled for coronary artery bypass grafting. Kardiol Pol, 2010, 68:789-794.
7. Karoli NA, Dolishniaia GR, Rebrov AP. Arterial rigidity in patients with chronic obstructive pulmonary disease. Klin Med (Mosk), 2012, 90:38-42.
8. 郭璐, 解郑良, 刘跃建, 等.慢性阻塞性肺疾病患者合并动脉粥样硬化的危险因素研究.中国呼吸与危重监护杂志, 2011, 10:376-379.
9. 文富强, 贺蓓.慢性阻塞性肺疾病全球创议(2011年修订版)解读.中华医学杂志, 2012, 92: 939-940.
10. Rodriguez-Macias KA, Lind L, Naessen T. Thicker carotid intima layer and thinner media layer in subjects with cardiovascular diseases. An investigation using noninvasive high-frequency ultrasound. Atherosclerosis, 2006, 189:393-400.
11. Grant EG, Benson CB, Moneta GL, et al. Carotid artery stenosis: gray-scale and Doppler US diagnosis--Society of Radiologists in Ultrasound Consensus Conference. Radiology, 2003, 229:340-346.
12. 周永昌, 郭万学, 主编.超声医学.第4版.北京:科学技术文献出版社, 2006, 717.
13. Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J, 2005, 26: 319-338.
14. Topsakal R, Kalay N, Ozdogru I, et al. Effects of chronic obstructive pulmonary disease on coronary atherosclerosis. Heart Vessels, 2009, 24:164-168.
15. Komnata K. The influence of inflammatory process on the ventilatory impairment in patients with stable chronic obstructive pulmonary disease. Pneumonol Alergol Pol, 2010, 78:271-278.
16. Polikutina OM, Slepynina YS, Bazdyrev ED, et al. Rate of detection of atherosclerosis in patients with ST elevation myocardial infarction and concomitant chronic obstructive pulmonary disease of light or moderate degree of severity. Kardiologiia, 2015, 55:26-31.
17. Fox IH. Metabolic basis for disorders of purine nucleotide degradation. Metabolism, 1981, 30:616-634.
18. Elsayed NM, Nakashima JM, Postlethwait EM. Measurement of uric acid as a marker of oxygen tension in the lung. Arch Biochem Biophys, 1993, 302:228-232.
19. Ruggiero C, Cherubini A, Ble A, et al. Uric acid and inflammatory markers. Eur Heart J, 2006, 27:1174-1181.
20. Bartziokas K, Papaioannou AI, Loukides S, et al. Serum uric acid as a predictor of mortality and future exacerbations of COPD. Eur Respir J, 2014, 43:43-53.
21. Pascual-Figal DA, Hurtado-Martínez JA, Redondo B, et al. Hyperuricaemia and long-term outcome after hospital discharge in acute heart failure patients. Eur J Heart Fail, 2007, 9:518-524.
22. Rubinsztajn R, Przyby owski T, Karwat K, et al. Patients with chronic obstructive pulmonary disease (COPD)-similarities and differences of the study group participating in the project of National Center for Research and Development project "Chronic obstructive pulmonary disease (COPD)-systemic disease, the biggest threat of XXI century". Pol Merkur Lekarski, 2015, 39:359-363.
23. Enright PL. Smoking, lung function, and atherosclerosis in the 5, 000 elderly participants of the cardiovascular health study. Am J Geriatr Cardiol, 1994, 3:35-38.
24. Tabara Y, Muro S, Takahashi Y, et al. Airflow limitation in smokers is associated with arterial stiffness: the Nagahama Study. Atherosclerosis, 2014, 232:59-64.
25. Pan J, Xu L, Cai SX, et al. The association of pulmonary function with carotid atherosclerosis in older Chinese: Guangzhou Biobank Cohort Study-CVD Subcohort. Atherosclerosis, 2015, 243:469-476.
26. Engstr m G, Hedblad B, Valind S, et al. Asymptomatic leg and carotid atherosclerosis in smokers is related to degree of ventilatory capacity: longitudinal and cross-sectional results from 'Men born in 1914', Sweden. Atherosclerosis, 2001, 155:237-243.
27. Galal W, van Domburg RT, Feringa HH, et al. Relation of body mass index to outcome in patients with known or suspected coronary artery disease. Am J Cardiol, 2007, 99:1485-1490.
28. Blum A, Simsolo C, Sirchan R, et al. "Obesity paradox" in chronic obstructive pulmonary disease. Isr Med Assoc J, 2011, 13:672-675.

Chinese Journal of Respiratory and Critical Care Medicine

Analysis of Risk Factors for Carotid Atherosclerotic Stenosis in Senior Chronic Obstructive Pulmonary Disease Patients

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