Title: Evaluation of Carotid Intima –Media Thickness in Patients with Chronic Obstructive Pulmonary Disease
Authors: Dr Rajani .M., Dr Manoj.D.K, Dr Smithanair
DOI: http://dx.doi.org/10.18535/jmscr/v4i3.02
Abstract
Background: Chronic obstructive pulmonary disease [COPD] can be associated with major comorbid diseases including atherosclerosis of blood vessels.Carotid atherosclerosis as characterised by increased intima-media thickness [IMT] is an indicator of atherosclerosis burden and cardiovascular disease risk.
Aims: To evaluate the changes of carotid intima-media thickness in patients with chronic obstructive pulmonary disease. To determine the relation between severity of COPD and increased intima-media thickness.
Materials and Methods: A case control study was done among 40 patients with COPD and 40 healthy subjects(Aged 50-65yrs) using carotid B mode duplex ultrasonography with high frequency probe (7.5 MHz).Levels more than or equal to 1.2mm was defined as increased IMT.The severity of COPD was assessed by spirometry. An additional risk factor which was studied was plaques in carotid artery.
Results: Twenty six patients with COPD and ten from control group had increased Intima-media thickening, which was highly significant[p=0.000]. The relation between severity of COPD and increased IMT was clinically significant but statistically notsignificant[p=.069].
Thirty patients with chronic obstructive pulmonary disease and twelve from control group had increased incidence of soft plaques, which was also highly significant[p =0.000].
Conclusion: Carotid intima media thickness measurement can be effectively used as an early predictor of cardiovascular risk assessment in patients with chronic obstructive pulmonary disease.
Key Words: COPD,Carotid Intima -Media Thickeness, Atherosclerosis
References
1. Pauwels R, Buist A, Calverley P, Jenkins C, Hurd S.Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. NHLBI/WHO global initiative for chronic obstructivelung disease (GOLD) workshop summary. Am J RespirCrit Care Med 2001; 163: 1256-76.
2. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of Chronic ObstructivePulmonary Disease. NHLBI/WHO workshop report. Bethesda, National Heart, Lung and Blood Institute,April 2001; Update of the Management SectionsGOLD website 2003
3. Agusti AG. Systemic effects of chronic obstructive pulmonarydisease. Proc Am Thorac Soc 2005; 2(4): 367-70.
4. Sin DD, Man SFP. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc 2005; 2(1): 8-11.
5. Fimognari FL, Scarlata S, Conte ME, Incalzi RA.Mechanisms of atherothrombosis in chronic obstructive pulmonary disease. International Journal of COPD 2008; 3(1): 89-96.
6. Baldassarre D, Amato M, Bondioli A, et al. Carotid artery intima-media thickness measured by ultrasonography i n normal clinical practice correlates well with atherosclerosis risk factors. Stroke 2000; 31(10) 2426-30
7. Kim SJ, Yoon DW, Lee EJ, Hur GY, Jung KH, Lee SY,et al. Carotid atherosclerosis in patients with untreatedchronic obstructive pulmonary disease. Int J Tuberc Lung Dis 2011; 15
8. D.D. Sin, L. Wu, S.F. ManThe relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literatureChest, 127 (2005 Jun), pp. 1952–1959
9. D.D. Sin, S.F. ManChronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality Proc Am Thorac Soc, 2 (2005), pp. 8–11
10. Aryal S, Diaz-Guzman E, Mannino DM. Epidemiology of comorbidities in chronic obstructive pulmonary disease: Clusters, phenotypes and outcomes. Italian Journal of Medicine 2012;6:276-84.
11. Fabbri LM, Luppi F, Beghé B, Rabe KF. Complex chronic comorbidities of COPD. Eur Respir J 2008;31:204-12
12. Hole DJ, Watt GC, Davey-Smith G, Hart CL, Gillis CR, Hawthorne VM. Impaired lung function and mortality risk in men and women: Findings from the renfrew and paisley prospective population study. BMJ 1996;313:711-6.
13. Ross R. The pathogenesis of atherosclerosis: A perspective for the 1990s. Nature 1993;362:801-9.
14. Faxon DP, Fuster V, Libby P, Beckman JA, Hiatt WR, Thompson RW, et al.; American Heart Association. Atherosclerotic vascular disease conference: Writing Group III: Pathophysiology. Circulation 2004;109: 2617-25
15. Schroeder EB, Welch VL, Evans GW, Heiss G. Impaired lung function and subclinical atherosclerosis. The ARIC study. Atherosclerosis 2005;180:367-73
16. Truelsen T, Prescott E, Lange P, Boysen G. Lung functionand risk of fatal and non-fatal stroke. TheCopenhagen City Heart Study. Int J Epidemiol 2001;30(1): 145-51.
17. Pobeha P, Skyba P, Joppa P, Kluchova Z, Szaboova E,Tkac I, et al. Carotid intima-media thickness in patients with chronic obstructive pulmonary disease. Bratisl Lek Listy 2011; 112(1): 24-8.
18. Besir FH, Aydin LY, Yazgan O, Dumlu T, Erkan ME,Onder E, et al. Evaluation of carotis intima media thickness in chronic obstructive pulmonary disease patients. Tuberk Toraks 2012; 60(3): 238-245.
19. van Gestel YR, Flu WJ, van Kuijk JP, Hoeks SE, BaxJJ, Sin DD, et al. Association of COPD with carotid wall intima-media thickness in vascular surgery patients. Respiratory Medicine 2010; 104(5): 712-16.
20. Kim SJ, Yoon DW, Lee EJ, Hur GY, Jung KH, Lee SY,et al. Carotid atherosclerosis in patients with untreated chronic obstructive pulmonary disease. Int J TubercLung Dis 2011; 15(9): 1265-70.
21. Sin DD, Anthonisen NR, Soriano JB, Agusti AG.Mortality in COPD: role of comorbidities. Eur Respir J2006; 28(6): 1245-57.
22. Sin DD, Wu L, Man SF. The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature. Chest 2005; 127(6): 1952-59.
23. Jousilahti P,Vartiainen E, Tuomilehto J, et al. Symptoms of chronic bronchitis and the risk of coronary disease.Lancet 1996; 348(9027): 567-72.
24. Camilli AE, Robbins DR, Lebowitz MD. Death certificate reporting of confirmed airways obstructive disease.Am J Epidemiol 1991; 133(8): 795-800.
25. Zureik M, Benetos A, Neukirch C, Courbon D, Bean K,Thomas F, et al. Reduced pulmonary function is associated with central arterial stiffness in men. Am J Respir Crit Care Med 2001; 164(12): 2181-5.
26. Omer Karakas1, Nesat Cullu2, Ekrem Karakas1, Zafer Hasan Ali Sak3, Murat Yildizhan1, Erdem Daglioglu1, OsmanKonukoglu1, Ferit Dogan1 Evaluation Of Carotid Intima-Media Thickness In The Patients With Chronicobstructive PULMONARY Diseaseacta Medica Mediterranea.
27. Yvette R.B.M. van Gestela, Willem-Jan Flub, Jan-Peter van Kuijkb, Sanne E. Hoeksa,Jeroen J. axc, Don D. Sind,Don Poldermans Association of COPD with carotid wall intima-mediathicknein vascular surgery patientsRespiratory MedicineVolume 104, Issue 5, May 2010, Pages 712– 71.
28. D.D. Sin, S.F. Man Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease
29. M.W. Lorenz, P. Karbstein, H.S. Markus, M. SitzerHigh-sensitivity C-reactive protein is not associated with carotid intima-media progression: the carotid atherosclerosis progression studyStroke, 38 (2007 Jun), pp. 1774–177
30. Iwamoto, A. Yokoyama, Y. Kitahara, N. Ishikawa, Y. Haruta, K. Yamane, et al.Airflow limitation in smokers is associated with subclinical atherosclerosisAm J Respir Crit Care Med, 179 (2009 Jan 1), pp. 35–40
31. N.R. Anthonisen, J.E. Connett, J.P. Kiley, M.D. Altose, W.C. Bailey, A.S. Buist, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study JAMA, 272 (1994 Nov 16), pp. 1497–1505
32. L.P. McGarvey, M. John, J.A. Anderson, M. Zvarich, R.A. Wise Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint Committee Thorax, 62 (2007 May), pp. 411–415