OJRD  Vol.3 No.1 , February 2013
Leg Atherosclerosis in Japanese COPD Patients: Prevalence of Undiagnosed Peripheral Artery Disease and Association between Leg Atherosclerosis and Clinical Indices
ABSTRACT
Introduction: Several studies have suggested that decreased FEV1 is associated with cardiovascular risk in COPD patients. Objective: To identify the prevalence of undiagnosed peripheral artery disease (PAD) and the relationship between leg atherosclerosis and clinical indices, which predict COPD mortality in Japanese COPD patients. Methods: We performed a cross-sectional study in 51 COPD patients and 51 age-matched, healthy control smokers. We measured ankle-brachial index (ABI) as a marker of atherosclerosis of the legs, pulmonary function, body mass index, modified Medical Research Council (MMRC) dyspnea scale, and smoking pack-years. We also calculated the ADO index (Age, Dyspnea, and Obstruction), an established predictor of mortality in COPD patients. Co-morbidities including diabetes mellitus, hypertension, and hypercholesterolemia were identified from blood laboratory tests and medical records. Results: Five subjects (9.8%) had an ABI < 0.9. ABI was significantly lower in the COPD patients than in the healthy control smokers (p < 0.05). The prevalence of PAD was marginally higher in COPD patients than in control smokers (p = 0.09), with the prevalence of ABI < 1.0 being significantly higher in COPD patients than in control smokers (p = 0.04). In the COPD patients, ABI showed significant correlations with age (p = 0.006), FEV1 (p = 0.004), smoking pack-years (p = 0.047), MMRC dyspnea scale (p = 0.0005), SaO2 (p = 0.001), andADOindex (p < 0.001). Multiple linear regression modeling showed the factors associated independently with ABI were age, FEV1, smoking pack-years, MMRC dyspnea scale, and SaO2. Conclusion: The risk of leg atherosclerosis in Japanese COPD patients is higher than in smokers without COPD. Leg atherosclerosis in COPD patients is associated with clinical indices that predict COPD mortality.

Cite this paper
H. Matsuoka, Y. Matsumoto, K. Kimura, M. Koyama, T. Uzu, Y. Koma, K. Fukumitsu, Y. Kasai, N. Nakashima, D. Masuya, H. Yoshimatsu and Y. Suzuki, "Leg Atherosclerosis in Japanese COPD Patients: Prevalence of Undiagnosed Peripheral Artery Disease and Association between Leg Atherosclerosis and Clinical Indices," Open Journal of Respiratory Diseases, Vol. 3 No. 1, 2013, pp. 25-30. doi: 10.4236/ojrd.2013.31005.
References
[1]   C. J. Murray and A. D. Lopez, “Global Mortality, Disability, and the Contribution of Risk Factors: Global Burden of Disease Study,” Lancet, Vol. 349, No. 9063, 1997, pp. 1436-1442. doi:10.1016/S0140-6736(96)07495-8

[2]   L. M. Fabbri, F. Luppi, B. Beghe, et al., “Complex Chronic Comorbidities of COPD,” European Respiratory Journal, Vol. 31, No. 1, 2008, pp. 204-212. doi:10.1183/09031936.00114307

[3]   J. D. Maclay, D. A. McAllister and W. Macnee, “Cardiovascular Risk in Chronic Obstructive Pulmonary Disease,” Respirology, Vol. 12, No. 5, 2007, pp. 634-641. doi:10.1111/j.1440-1843.2007.01136.x

[4]   D. D. Sin and S. F. Man, “Chronic Obstructive Pulmonary Disease as a Risk Factor for Cardiovascular Morbidity and Mortality,” Proceedings of the American Thoracic Society, Vol. 2, No. 1, 2005, pp. 8-11. doi:10.1513/pats.200404-032MS

[5]   P. M. Calverley, J. A. Anderson, B. Celli, et al., “Salmeterol and Fluticasone Propionate and Survival in Chronic Obstructive Pulmonary Disease,” The New England Journal of Medicine, Vol. 356, No. 8, 2007, pp. 775-789. doi:10.1056/NEJMoa063070

[6]   R. A. Pauwels, C. G. Lofdahl, L. A. Laitinen, et al., “LongTerm Treatment with Inhaled Budesonide in Persons with Mild Chronic Obstructive Pulmonary Disease Who Continue Smoking,” The New England Journal of Medicine, Vol. 340, No. 25, 1999, pp. 1948-1953. doi:10.1056/NEJM199906243402503

[7]   W. MacNee, “Pathogenesis of Chronic Obstructive Pulmonary Disease,” Proceedings of the American Thoracic Society, Vol. 2, No. 4, 2005, pp. 258-266. doi:10.1513/pats.200504-045SR

[8]   H. J. Schunemann, J. Dorn, B. J. Grant, et al., “Pulmonary Function Is a Long-Term Predictor of Mortality in the General Population: 29-Year Follow-Up of the Buffalo Health Study,” Chest, Vol. 118, No. 3, 2000, pp. 656-664. doi:10.1378/chest.118.3.656

[9]   D. D. Sin, L. Wu and S. F. Man, “The Relationship Between Reduced Lung Function and Cardiovascular Mortality: A Population-Based Study and a Systematic Review of the Literature,” Chest, Vol. 127, No. 6, 2005, pp. 1952-1959. doi:10.1378/chest.127.6.1952

[10]   S. M. Curkendall, C. DeLuise, J. K. Jones, et al., “Cardiovascular Disease in Patients with Chronic Obstructive Pulmonary Disease, Saskatchewan Canada Cardiovascular Disease in COPD Patients,” Annals of Epidemiology, Vol. 16, No. 1, 2006, pp. 63-70. doi:10.1016/j.annepidem.2005.04.008

[11]   M. Zureik, A. Benetos, C. Neukirch, et al., “Reduced Pulmonary Function Is Associated with Central Arterial Stiffness in Men,” American Journal of Respiratory and Critical Care Medicine, Vol. 164, No. 12, 2001, pp. 2181-2185.

[12]   E. B. Schroeder, V. L. Welch, G. W. Evans, et al., “Impaired Lung Function and Subclinical Atherosclerosis. The ARIC Study,” Atherosclerosis, Vol. 180, No. 2, 2005, pp. 367-373. doi:10.1016/j.atherosclerosis.2004.12.012

[13]   D. A. McAllister, J. D. Maclay, N. L. Mills, et al., “Arterial Stiffness Is Independently Associated with Emphysema Severity in Patients with Chronic Obstructive Pulmonary Disease,” American Journal of Respiratory and Critical Care Medicine, Vol. 176, No. 12, 2007, pp. 1208-1214. doi:10.1164/rccm.200707-1080OC

[14]   H. Iwamoto, A. Yokoyama, Y. Kitahara, et al., “Airflow Limitation in Smokers Is Associated with Subclinical Atherosclerosis,” American Journal of Respiratory and Critical Care Medicine, Vol. 179, No. 1, 2009, pp. 35-40. doi:10.1164/rccm.200804-560OC

[15]   A. T. Hirsch, Z. J. Haskal, N. R. Hertzer, et al., “ACC/ AHA 2005 Practice Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop,” Circulation, Vol. 113, No. 11, 2006, pp. e463-e654.

[16]   M. H. Criqui, J. O. Denenberg, R. D. Langer, et al., “The Epidemiology of Peripheral Arterial Disease: Importance of Identifying the Population at Risk,” Vascular Medicine, Vol. 2, No. 3, 1997, pp. 221-226.

[17]   J. Ness, W. S. Aronow, “Prevalence of Coexistence of Coronary Artery Disease, Ischemic Stroke, and Peripheral Arterial Disease in Older Persons, Mean Age 80 Years, in an Academic Hospital-Based Geriatrics Practice,” Journal of the American Geriatrics Society, Vol. 47, No. 10, 1999, pp. 1255-1256.

[18]   J. I. Weitz, J. Byrne, G. P. Clagett, et al., “Diagnosis and Treatment of Chronic Arterial Insufficiency of the Lower Extremities: A Critical Review,” Circulation, Vol. 94, No. 11, 1996, pp. 3026-3049. doi:10.1161/01.CIR.94.11.3026

[19]   D. R. Jacobs Jr., H. Adachi, I. Mulder, et al., “Cigarette Smoking and Mortality Risk: Twenty-Five-Year FollowUp of the Seven Countries Study,” The Archives of Internal Medicine, Vol. 159, No. 7, 1999, pp. 733-740. doi:10.1001/archinte.159.7.733

[20]   K. Nishimura, T. Izumi, M. Tsukino, et al., “Dyspnea Is a Better Predictor of 5-Year Survival than Airway Obstruction in Patients with COPD,” Chest, Vol. 121, No. 5, 2002, pp. 1434-1440. doi:10.1378/chest.121.5.1434

[21]   American Thoracic Society, “Standardization of Spirometry,” American Journal of Respiratory and Critical Care Medicine, Vol. 152, No. 3, 1995, pp. 1107-1136.

[22]   D. A. Mahler, C. K. Wells, Evaluation of Clinical Methods for Rating Dyspnea,” Chest, Vol. 93, No. 3, 1988, pp. 580-586. doi:10.1378/chest.93.3.580

[23]   M. A. Puhan, J. Garcia-Aymerich, M. Frey, et al., “Expansion of the Prognostic Assessment of Patients with Chronic Obstructive Pulmonary Disease: The Updated BODE Index and the ADO Index,” Lancet, Vol. 374, No. 9691, 2009, pp. 704-711. doi:10.1016/S0140-6736(09)61301-5

[24]   O. Castagna, A. Boussuges, E. Nussbaum, et al., “Peripheral Arterial Disease: An Underestimated Aetiology of Exercise Intolerance in Chronic Obstructive Pulmonary Disease Patients,” European Journal of Cardiovascular Prevention & Rehabilitation, Vol. 15, No. 3, 2008, pp. 270-277. doi:10.1097/HJR.0b013e3282f009a9

[25]   T. Fujiwara, S. Saitoh, et al., “Prevalence of Asymptomatic Arteriosclerosis Obliterans and Its Relationship with Risk Factors in Inhabitants of Rural Communities in Japan: Tanno-Sobetsu study,” Atherosclerosis, Vol. 177, No. 1, 2004, pp. 83-88.

[26]   H. Ohnishi, Y. Sawayama, et al., “Risk Factors for and the Prevalence of Peripheral Arterial Disease and Its Relationship to Carotid Atherosclerosis: The Kyushu and Okinawa Population Study (KOPS),” Journal of Atherosclerosis and Thrombosis, Vol. 30, Vol. 17, 2010, pp. 751758.

[27]   F. G. Fowkes, G. D. Murray, I. Butcher, et al., “Ankle Brachial Index Combined with Framingham Risk Score to Predict Cardiovascular Events and Mortality: A MetaAnalysis,” Journal of the American Medical Association, Vol. 300, No. 2, 2008, pp. 197-208. doi:10.1001/jama.300.2.197

[28]   G. Hartmann, M. Tschop, R. Fischer, et al., “High Altitude Increases Circulating Interleukin-6, Interleukin-1 Receptor Antagonist and C-Reactive Protein,” Cytokine, Vol. 12, No. 3, 2000, pp. 246-252. doi:10.1006/cyto.1999.0533

[29]   V. Savransky, A. Nanayakkara, J. Li, et al., “Chronic Intermittent Hypoxia Induces Atherosclerosis,” American Journal of Respiratory and Critical Care Medicine, Vol. 175, No. 12, 2007, pp. 1290-1297. doi:10.1164/rccm.200612-1771OC

[30]   G. Engstrom, O. Melander, B. Hedblad, ‘Population-Based Study of Lung Function and Incidence of Heart Failure Hospitalisations,” Thorax, Vol. 65, No. 7, 2010, pp. 633-638. doi:10.1136/thx.2010.135392

[31]   B. R. Celli, C. G. Cote, J. M. Marin, et al., “The BodyMass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index in Chronic Obstructive Pulmonary Disease,” The New England Journal of Medicine, Vol. 350, No. 10, 2004, pp. 1005-1012. doi:10.1056/NEJMoa021322

[32]   M. McKenna, S. Wolfson and L. Kuller, “The Ratio of Ankle and Arm Arterial Pressure as an Independent Predictor of Mortality,” Atherosclerosis, Vol. 87, No. 2, 1991, pp. 119-128. doi:10.1016/0021-9150(91)90014-T

[33]   M. T. Vogt, M. McKenna, S. J. Anderson, et al., “The Relationship between Ankle-Arm Index and Mortality in Older Men and Women,” Journal of the American Geriatrics Society, Vol. 41, No. 5, 1993, pp. 523-530.

[34]   G. C. Leng, F. G. Fowkes, A. J. Lee, et al., “Use of Ankle Brachial Pressure Index to Predict Cardiovascular Events and Death: A Cohort Study,” British Medical Journal, Vol. 313, No. 7070, 1996, pp. 1440-1444. doi:10.1136/bmj.313.7070.1440

[35]   H. E. Resnick, R. S. Lindsay, M. M. McDermott, et al., “Relationship of High and Low Ankle Brachial Index to All-Cause and Cardiovascular Disease Mortality: The Strong Heart Study,” Circulation, Vol. 109, No. 6, 2004, pp. 733-739. doi:10.1161/01.CIR.0000112642.63927.54

[36]   R. Schulz, Seeger, et al., “Changes in Extracranial Arteries in Obstructive Sleep Apnoea,” European Respiratory Journal, Vol. 25, No. 1, 2005, pp. 69-74.

 
 
Top