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Cardiovascular Ultrasound

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Open Access 01-12-2024 | Chronic Obstructive Lung Disease | Research

Evaluation of atherosclerosis as a risk factor in COPD patients by measuring the carotid intima-media thickness

Authors: Ali Firincioglulari, Hakan Erturk, Mujgan Firincioglulari, Cigdem Biber

Published in: Cardiovascular Ultrasound | Issue 1/2024

Abstract

Background

This study aimed to evaluate atherosclerosis as comorbidity by measuring the carotid (bulb and common carotid artery) Carotid intima-media thickness in COPD-diagnosed patients and to evaluate the relationship of atherosclerosis with the prevalence of COPD, hypoxemia and hypercapnia.

Methods

This study was conducted out between January 2019-December 2019 consisting of a total of 140 participants (70 COPD-diagnosed patients-70 healthy individuals). The COPD-diagnosed patients have been planned according to the selection and diagnosis criteria as per the GOLD 2019 guide. It is planned to evaluate as per prospective matching case-control study of the carotid thickness, radial gas analysis, spirometric and demographic characteristics of COPD diagnosed patients and healthy individuals.

Results

The average Carotid intima-media thickness in COPD patients was 0.8746±0.161 (p<0.05), and the thickness of the carotid bulb was 1.04±0.150 (p<0.05). In the control group, the average CCA intima-media thickness was 0.6650±0.139 (p<0.05), and the thickness of the carotid bulb was 0.8250±0.15(p<0.05) For the carotid thickness that has increased in COPD diagnosed patients a significant relationship is determined between hypoxemia (p<0.05) and hypercapnia(p<0.05). A significant relationship determined between CIMT and severity of COPD (p<0.05) The CIMT was high in COPD patients with hypoxemia and hypercapnia(p<0.05).

Conclusion

Significant difference was determined between the severity (grades) of COPD (mild, moderate, severe, very severe) in carotid thickness. Also, CIMT was found to be high in patients who is in the early phases of the prevalence of COPD. In COPD-diagnosed patients, it was determined that severity of COPD, hypoxemia, hypercapnia and age were determining factors of atherosclerosis.

Graphical Abstract

Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chroni c Obstructive Lung Disease (GOLD) 2020 update. Available from: http: //goldcopd.org.

Bourdin A, Burgel PR, Chanez P, Garcia G, Perez T, Roche N. Recent advances in COPD: pathophysiology, respiratory physiology and clinical aspects, including comorbidities. Eur Respir Rev. 2009;18:198–212.PubMedCrossRef

Maclay JD, MacNee W. Cardiovascular disease in COPD: mechanisms. Chest. 2013;143:798–807.PubMedCrossRef

Lahousse L, van den Bouwhuijsen QJ, Loth DW, Joos GF, Hofman A, Witteman JC, et al. Chronic obstructive pulmonary disease and lipid core carotid artery plaques in the elderly: the Rotterdam Study. Am J Respir Crit Care Med. 2013;187:58–64.PubMedCrossRef

Karakas OM, Cullu N, Karakas EK, Sak ZH, Yildizhan MU, Daglioglu E, et al. Evaluation of carotid intima-media thickness in the patients with chronic obstructive pulmonary disease. Acta Med Mediterr. 2013;29:265.

Balta S, Demirkol S, Kucuk U, Arslan Z, Unlu M, Veliyev V. Carotid intima-media thickness is a relatively inexpensive and favorable prognostic marker in patients with spondyloarthritis. Sao Paulo Med J. 2013;131:436–8.PubMedCrossRef

Ogata T, Yasaka M, Yamagishi M, Seguchi O, Nagatsuka K, Minematsu K. Atherosclerosis found on carotid ultrasonography is associated with atherosclerosis on coronary intravascular ultrasonography. J Ultrasound Med. 2005;24:469–74.PubMedCrossRef

Fimognari FL, Scarlata S, Conte ME, Incalzi RA, Fimognari FL, Scarlata S, et al. Mechanisms of atherothrombosis in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2008;3:89.PubMedPubMedCentralCrossRef

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;112:24.PubMed

10.

Lee HY, Oh BH. Aging and arterial stiffness. Circulation. 2010;74:2257–62.CrossRef

11.

Galal-Eldin M, Ahmad E, Hafez M, Sobh E, Alrayes M. Telomere length in chronic obstructive pulmonary disease. Egypt J Bronchol. 2015;9:20.CrossRef

12.

Minamino T, Miyauchi H, Yoshida T, Ishida Y, Yoshida H, Komuro I. Endothelial cell senescence in human atherosclerosis role of telomere in endothelial dysfunction. Circulation. 2002;105:1541–4.PubMedCrossRef

13.

Benetos A, Okuda K, Lajemi M, Kimura M, Thomas F, Skurnick J, et al. Telomere length as an indicator of biological aging the gender effect and relation with pulse pressure and pulse wave velocity. Hypertension. 2001;37:381–5.PubMedCrossRef

14.

Maclay JD, Mcallister DA, Macnee W. Cardiovascular risk in chronic obstructive pulmonary disease. Respirology. 2007;12:634–41.PubMedCrossRef

15.

Invernizzi G. Persistence of systemic inflammation in COPD in spite of smoking cessation. Multidiscip Respir Med. 2011;6:210–1.PubMedPubMedCentralCrossRef

16.

Savransky V, Nanayakkara A, Li J, Bevans S, Smith PL, Rodriguez A, et al. Chronic intermittent hypoxia induces atherosclerosis. Am J Respir Crit Care Med. 2007;175:1290–7.PubMedPubMedCentralCrossRef

17.

Maclay JD, McAllister DA, Mills NL, Paterson FP, Ludlam CA, Drost EM, et al. Vascular dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2009;180:513–20.PubMedCrossRef

18.

van Gestel YR, Flu WJ, van Kuijk JP, Hoeks SE, Bax JJ, Sin DD, et al. Association of COPD with carotid wall intima-media thickness in vascular surgery patients. Respir Med. 2010;104:712–6.PubMedCrossRef

19.

Simova I. Intima-media thickness: Appropriate evaluation and proper measurement, described. E-J ESC Council Cardiol Pract. 2015;13:21.

20.

Jarauta E, Mateo-Gallego R, Bea A, Burillo E, Calmarza P, Civeira F. Carotid intima-media thickness in subjects with no cardiovascular risk factors. Rev Esp Cardiol. 2010;63:97–102.PubMedCrossRef

21.

Acharya UR, Faust O, Sree SV, Molinari F, Saba L, Nicolaides A, et al. An Accurate and Generalized Approach to Plaque Characterization in 346 Carotid Ultrasound Scans. IEEE Trans Instrument Meas. 2012;61(4):1045–53.CrossRef

22.

Acharya UR, Krishann MMR, Sree SV, Sanches J, Shafique H, et al. Plaque tissue characterization and classification in ultrasound carotid scans: a paradigm for vascular feature amalgamation. IEEE Trans Instrum Meas. 2013;62(2):392–400.CrossRef

23.

Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. General considerations for lung function testing. Eur Respir J. 2005;26:153–61.PubMedCrossRef

24.

Seth S, Goyal NK, Jagia P, Gulati G, Karthikeyan G, Sharma S, et al. Carotid intima-medial thickness as a marker of disease activity in Takayasu’s arteritis. Int J Cardiol. 2006;108(3):385–90.PubMedCrossRef

25.

Singh D, Agusti A, Anzueto A, et al. Global Strategy for the Diagnosis, Management, and Prevent on of Chronic Obstructive Lung Disease: the GOLD science committe report 2019. Eur Respir J. 2019;18:1–11.

26.

Okutan O, Ayten Ö. İstanbul Chronic Obstructive Pulmonary Disease and Comorbidities Respiratory. Jl Respir. 2012;14(3):181–3 Letter to the editör.

27.

Dalal AA, Shah M, Lunacsek O, Hanania NA. Clinical and economic burden of patients diagnosed with COPD with comorbid cardiovascular disease. Respir Med. 2011;105:1516–22. https://doi.org/10.1016/j.rmed.2011.04.005.CrossRefPubMed

28.

Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J. 2009;33:1165–85. https://doi.org/10.1183/09031936.00128008.CrossRefPubMed

29.

Bhatt SP, Wells JM, Dransfield MT. Cardiovascular disease in COPD: a call for action. Lancet Respir Med. 2014;2:783–5. https://doi.org/10.1016/S2213-2600(14)70197-3.CrossRefPubMed

30.

Sin DD, Paul Man SF. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc. 2005;2:8–11. https://doi.org/10.1513/pats.200404-032MS.CrossRefPubMed

31.

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;127:1952–9. https://doi.org/10.1378/chest.127.6.1952.CrossRefPubMed

32.

Calverley PM, Anderson JA, Celli B, Ferguson GT, Jenkins C, Jones PW, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356(8):775–89. https://doi.org/10.1056/NEJMoa063070. (PMID: 17314337).CrossRefPubMed

33.

Barger G, Dale HH. Chemical structure and sympathomimetic action of amines. J Physiol. 1910;41:19–59.PubMedPubMedCentralCrossRef

34.

Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension, and cardiovascular disease in chronic obstructive pulmonary disease. Eur Respir J. 2008;32:962–269.PubMedCrossRef

35.

Sin DD, Anthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: role of comorbidities. Eur Respir J. 2006;28:1245–57.PubMedCrossRef

36.

Fabbri LM, Rabe KF. From COPD to chronic systemic inflammatory syndrome? Lancet. 2007;370:797–9.PubMedCrossRef

37.

Gan WQ, Man SFP, Senthilselvan A, Sin DD. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic rewiew and meta-analysis. Thorax. 2004;59:574–80.PubMedPubMedCentralCrossRef

38.

Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Desvarieux M, et al. Mannheim intima-media thickness consensus. Cerebrovasc Dis. 2004;18:346–9.PubMedCrossRef

39.

van den Oord SC, Sijbrands EJ, ten Kate GL, van Klaveren D, van Domburg RT, van der Steen AF, et al. Carotid intima-media thickness for cardiovascular risk assessment: systematic review and meta-analysis. Atherosclerosis. 2013;228(1):1–11.PubMedCrossRef

40.

Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and metaanalysis. Circulation. 2007;115:459–67.PubMedCrossRef

41.

Watase H, Sun J, Hippe DS, Balu N, Li F, Zhao X, et al. Carotid artery remodeling is segment specific: an in vivo study by vessel wall magnetic resonance imaging. Arterioscler Thromb Vasc Biol. 2018;38(4):927–34.PubMedPubMedCentralCrossRef

42.

Perktold K, Thurner E, Kenner T. Flow and stress characteristics in rigid walled and compliant carotid artery bifurcation models. Med Biol Eng Comput. 1994;32(1):19-26.161.PubMedCrossRef

43.

Stroud JS, Berger SA, Saloner D. Numerical analysis of flow through a severely stenotic carotid artery bifurcation. J Biomech Eng. 2002;124(1):9–20.PubMedCrossRef

44.

Ikeda N, Dey N, Sharma A, Gupta A, Bose S, Acharjee S, et al. Automated segmental-IMT measurement in thin/thick plaque with bulb presence in carotid ultrasound from multiple scanners: Stroke risk assessment. Comput Methods Programs Biomed. 2017;141:73–81.PubMedCrossRef

45.

Higgins MV, Thomu T. Incidence, prevalence and mortality intra and inter country differences. In: Hensloy MJ, Sounders NA, editors. Clinical epidemology of COPD. New York: Marcel Dekker Inc; 1989. p. 23–9.

46.

Ergen H, Saraç S, Saygı A, Arslan Z, Köklü S. Assessment of serum lipid values in COPD patients. Solunum. 2008;10:168–71.

47.

Ridker PM, Rifai N, Rose LL, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002;347:1557–65.PubMedCrossRef

48.

Eickhoff P, Valipour A, Kiss D, Schreder M, Cekici L, Geyer K, et al. Determinants of systemic vascular function in patients with stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2008;178:1211–8.PubMedCrossRef

49.

Kim SJ, Yoon DW, Lee EJ, Hur GY, Jung KH, Lee SY, et al. Carotid atherosclerosis in patients with nuntreated chronic obstructive pulmonary disease. Int J Tuberc Lung Dis. 2011;15:1265–70.PubMedCrossRef

50.

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. 1952;2005(127):9.

51.

Iwamoto H, Yokoyama A, Kitahara Y, Ishikawa N, Haruta Y, Yamane K, et al. Airflow limitation in smokers is associated with subclinical atherosclerosis. Am J Respir Crit Care Med. 2009;179:35–40.PubMedCrossRef

52.

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;164:2181–5.PubMedCrossRef

53.

Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults: the Bogalusa Heart Study. N Engl J Med. 1998;338:1650–6.PubMedCrossRef

54.

McGill HC Jr, McMahan CA. Determinants of atherosclerosis in the young Pathobiological determinants of atherosclerosis in youth (PDAY) research group. Am J Cardiol. 1998;82:30T-36T.PubMedCrossRef

55.

Basili S, Ferroni P, Vieri M, Cardelli P, Ceci F, Paradiso M, et al. Lipoprotein (a) serum levels in patients affected by chronic obstructive pulmonary disease. Atherosclerosis. 1999;147:249–52.PubMedCrossRef

56.

Radavuş C, Sunay D, Çaylan A. Evaluation of serum lipid levels in chronic obstructive pulmonary disease. Tur Toraks Der. 2010;11:55–61.CrossRef

57.

Ercan S, Çakan A, Dereli Ş, Özsöz A, Kalenci D. Investigating the serum lipid levels in chronic obstructive pulmonary disease. Tuberk Toraks. 2002;50:246–50.

58.

Hafez MR, Sobh E, Abo-Elkheir OI, Sakr LK. Atherosclerosis is Associated Comorbidity in Patients with Chronic Obstructive Pulmonary Disease: Ultrasound Assessment of Carotid Intima Media Thickness. Eurasian J Pulmonol. 2016;18:165–71.CrossRef

59.

Lattimore JD, Wilcox I, Nakhla S, Langenfeld M, Jessup W, Celermajer DS. Repetitive hypoxia increases lipid loading in human macrophages-a potentially atherogenic effect. Atherosclerosis. 2005;179:255–9.PubMedCrossRef

60.

Chen L, Einbinder E, Zhang Q, Hasday J, Balke CW, Scharf SM. Oxidative stress and left ventricular function with chronic intermittent hypoxia in rats. Am J Respir Crit Care Med. 2005;172:915–20.PubMedCrossRef

61.

Ozbay B, Ozgokce M, Asker M, Asker S. Association of Intermittent and Continuous Hypoxaemia with Carotid and Brachial Arterial Intima-media Thicknesses. West Indian Med J. 2016. pii: wimj.2015.370. https://doi.org/10.7727/wimj.2015.370.

62.

Chindhi S, Thakur S, Sarkar M, Negi PC. Subclinical atherosclerotic vascular disease in chronic obstructive pulmonary disease: Prospective hospital- based case control study. Lung India. 2015;32:137.PubMedPubMedCentralCrossRef

63.

Agricola E, Slavich M, Bertoglio L, Civilini E, Melissano G, Marone E, Rinaldi E, Fisicaro A, Marini C, Tufaro V, Margonato A, Chiesa R. Contrast-Enhanced TEE During Thoracic Endovascular Aortic Repair Procedure. JACC Cardiovasc Imaging. 2015;8(8):980–2. https://doi.org/10.1016/j.jcmg.2014.07.029. (PMID: 26271093).CrossRefPubMed

64.

Agricola E, Slavich M, Rinaldi E, Bertoglio L, Civilini E, Melissano G, Marone E, Fisicaro A, Marini C, Tufaro V, Cappelletti A, Margonato A, Chiesa R. Usefulness of contrast-enhanced transoesophageal echocardiography to guide thoracic endovascular aortic repair procedure. Eur Heart J Cardiovasc Imag. 2016;17(1):67–75. https://doi.org/10.1093/ehjci/jev118. (Epub 2015 Jun 1 PMID: 26034095).CrossRef

Title: Evaluation of atherosclerosis as a risk factor in COPD patients by measuring the carotid intima-media thickness
Authors: Ali Firincioglulari
Hakan Erturk
Mujgan Firincioglulari
Cigdem Biber
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Chronic Obstructive Lung Disease
Arterial Occlusive Disease
Hypoxemia
Stroke
Published in: Cardiovascular Ultrasound / Issue 1/2024
Electronic ISSN: 1476-7120
DOI: https://doi.org/10.1186/s12947-023-00322-8

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