Chronic Obstructive Pulmonary Disease (COPD)

SphygmoCor® offers individualized measurements of central arterial pressure waveform analysis and arterial stiffness, helping physicians assess and target arterial stiffness to reduce the high cardiovascular risk in patients with COPD.

A number of treatment options currently exist for COPD, including medications, inhaled treatments, oxygen supplementation, exercise training, and rehabilitation. The association of arterial stiffness with COPD provides a foundation for these measures to be used in investigating various strategies.

Measures of both aortic pulse wave velocity (PWV, the most common surrogate measure of arterial stiffness) and aortic augmentation index (AIx) have been shown to be highly reproducible in patients with COPD.[7] These measures have also been shown to be significant independent predictors of cardiovascular risk in a range of conditions, including hypertension, heart failure, and diabetes.[8,9]

Association between arterial stiffness and COPD

Arterial stiffness has been shown to be associated with COPD. A large number of studies have consistently demonstrated that aortic pulse wave velocity (PWV) is significantly increased in patients with COPD, compared to both healthy non-smokers and ex-smokers. [10,16]

This increase has been shown to exist across each decade of adult life[10] and in patients with mild-moderate COPD, as well as severe COPD.[15] Arterial stiffness in COPD patients has also been shown to be associated with left ventricular dysfunction,[17] skin elastin degradation,[14] and osteoporosis. [10]

Additionally, arterial stiffness increases with severity of COPD. Aortic PWV is higher in patients with more severe stages of COPD (Gold 3-4) compared with mild-moderate stages (Gold 1-2).[10,15]

Measures of central arterial pressure waveforms and wave reflections have also been reported to be higher in patients with COPD.[10,16,18]

Central aortic pressure, wave reflections and arterial stiffness are significantly higher in patients with COPD and have been shown to be associated with the severity of the condition.[3]

Measures of arterial stiffness are well-documented predictors of cardiovascular risk in a range of other conditions including hypertension, a frequent and important co-morbidity in COPD.[8]

There is a significant body of evidence in hypertension documenting the effects of pharmacological treatment on arterial stiffness.[27,29] Both pharmaceutical and non-pharmaceutical treatment strategies have been examined in patients with COPD with more positive results in patients with a higher baseline of arterial stiffness.

In a trial investigating statin treatment in COPD, patients treated with simvastatin experienced a non-significant fall in aortic PWV compared to treatment with a placebo. A significant reduction in aortic PWV was observed in those patients with a higher baseline aortic PWV (>10m/s).[19]

Similar results have been seen in a study examining fluticasone proprionate/salmeterol[20] and more recently in COPD patients treated with fluticasone furoate/vilanterol or tiotropium bromide,[21] where both treatments produced a reduction in aortic PWV in patients with elevated aortic PWV at baseline (>11 m/s).

As a large percentage of COPD patients have heart failure (and vice versa), the importance of assessing treatment in this group has been highlighted. The ability to switch between different beta blockers has been shown to be tolerated by heart failure patients with COPD and a short-term reduction in central blood pressure was observed via central arterial pressure waveform analysis when treated with carvedilol, with no change to brachial blood pressure.[22]

Non-pharmacological treatment via pulmonary rehabilitation has been shown to improve aortic PWV in patients with COPD.[13] The pulmonary rehabilitation program included exercise and nutrition and lifestyle modification over a 7-week period.

Citations and References

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1. WHO. Chronic Obstructive Pulmonary Disease. Fact Sheet No 315. 2015.
2. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management and Prevention of COPD. 2016.
3. Vivodtzev I et al. Arterial stiffness in COPD. Chest 2014;145(4):861-875.
4. Ford ES et al. COPD surveillance–United States, 1999-2011. Chest 2013;144(1):284-305.
5. Mannino DM et al. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 2008;32(4):962-969.
6. Cockcroft JR et al. Beta-blockade: benefits beyond blood pressure reduction? J Clin Hypertens (Greenwich) 2012;14(2):112-120.
7. Rodriguez-Miguelez P et al. Assessments of endothelial function and arterial stiffness are reproducible in patients with COPD. Int J Chron Obstruct Pulmon Dis 2015;10(1977-1986.
8. Ben-Shlomo et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol 2014;63(7):636-646.
9. Vlachopoulos C et al. The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation: Endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY) Society. Atherosclerosis 2015;241(2):507-532.
10. Sabit R et al. Arterial stiffness and osteoporosis in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007;175(12):1259-1265.
11. Maclay JD et al. Vascular dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009;180(6):513-520
12. Duckers JM et al. Cardiovascular and musculoskeletal co-morbidities in patients with alpha 1 antitrypsin deficiency. Respir Res 2010;11(173-
13. Gale NS et al. Does pulmonary rehabilitation address cardiovascular risk factors in patients with COPD? BMC Pulm Med 2011;11(20-
14. Maclay JD et al. Systemic elastin degradation in chronic obstructive pulmonary disease. Thorax 2012;67(7):606-612.
15. Cinarka H et al. Arterial stiffness measured via carotid femoral pulse wave velocity is associated with disease severity in COPD. Respir Care 2014;59(2):274-280.
16. Vanfleteren LE et al. Arterial stiffness in patients with COPD: the role of systemic inflammation and the effects of pulmonary rehabilitation. Eur Respir J 2014;43(5):1306-1315.
17. Sabit R et al. Sub-clinical left and right ventricular dysfunction in patients with COPD. Respir Med 2010;104(8):1171-1178.
18. Mills NL et al. Increased arterial stiffness in patients with chronic obstructive pulmonary disease: a mechanism for increased cardiovascular risk. Thorax 2008;63(4):306-311.
19. John ME et al. Cardiovascular and inflammatory effects of simvastatin therapy in patients with COPD: a randomized controlled trial. Int J Chron Obstruct Pulmon Dis 2015;10(211-221.
20. Dransfield MT et al. Effect of fluticasone propionate/salmeterol on arterial stiffness in patients with COPD. Respir Med 2011;105(9):1322-1330.
21. Pepin JL et al. Long-acting bronchodilators and arterial stiffness in patients with COPD: a comparison of fluticasone furoate/vilanterol with tiotropium. Chest 2014;146(6):1521-1530.
22. Jabbour A et al. Differences between beta-blockers in patients with chronic heart failure and chronic obstructive pulmonary disease: a randomized crossover trial. J Am Coll Cardiol 2010;55(17):1780-1787.
23. Edwards DG et al. Effect of exercise training on central aortic pressure wave reflection in coronary artery disease. Am J Hypertens 2004;17(6):540-543.
24. Mustata S et al. Impact of an exercise program on arterial stiffness and insulin resistance in hemodialysis patients. J Am Soc Nephrol 2004;15(10):2713-2718.
25. Toussaint ND t al. Impact of intradialytic exercise on arterial compliance and B-type natriuretic peptide levels in hemodialysis patients. Hemodial Int 2008;12(2):254-263.
26. Beck DT et al. Exercise training reduces peripheral arterial stiffness and myocardial oxygen demand in young prehypertensive subjects. Am J Hypertens 2013;26(9):1093-1102.
27. Protogerou AD e al. The effect of antihypertensive drugs on central blood pressure beyond peripheral blood pressure. Part I: (Patho)-physiology, rationale and perspective on pulse pressure amplification. Curr Pharm Des 2009;15(3):267-271.
28. Manisty CH et al. Meta-analysis of the comparative effects of different classes of antihypertensive agents on brachial and central systolic blood pressure, and augmentation index. Br J Clin Pharmacol 2013;75(1):79-92.
29. Trudeau L. Central blood pressure as an index of antihypertensive control: determinants and potential value. Can J Cardiol 2014;30(5 Suppl):S23-S28.