Subclinical Atherosclerosis in COPD Smokers: An Egyptian Randomized Controlled study
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Chronic Obstructive Pulmonary disease (COPD) is associated with increased morbidity and mortality from cardiovascular disease. Although a close association between COPD and atherosclerosis has been speculated, such scientific information is limited. Aim: The present study aimed to evaluate subclinical atherosclerosis in smokers with COPD. Subjects and Methods: This prospective randomized controlled study was carried out on 90 consecutive Egyptians; at Chest and Internal Medicine Departments of Benha University Hospitals, Benha, Egypt. All patients were consented. Study population was randomized into three groups, each comprized 30 patients. Group one included 30 smokers with COPD. Group two included 30 healthy smokers without lung function abnormalities and Group three included 30 healthy volunteers who never smoked before and with normal lung functions(control group). Subjects with diabetes, hyperlipidemia, acute infections, IHD, and respiratory diseases other than COPD were excluded beforehand. Complete medical history, full clinical and radiological examination, complete blood picture, liver function tests, renal function tests, fasting blood sugar, lipid profile, body mass index(BMI), C-reactive protein, ventilatory pulmonary function tests and carotid uhrasonogaphy were done to all subjects enrolled in the study. We determined Carotid intima- media thiclmess(IMT) and focal atheromatous plaques as an indicator of subclinical atherosclerosis. Results: Our findings demonstrated that mean carotid intima-mediathickness was greater in smokers with COPD than normal smokers group and control never smoke group.Also, focal carotid plaques were significantly more prevalent in COPD smokers group than normal smokers and control never smoke groups. Multivariate analysis showed significant association between thickened carotid intima media and decreased percent of predicted FEVI (P=0.001) and between plaques and Log C- reactive protein levels (P=0.013) ndependent of patient's age, number of smoked packs/ year, body mass index, peripheral mean arterial blood pressure, heart rate, blood glucose, and low density lipoprotein levels. In conclusion, our observations revealed that, COPD smokers had exaggerated subclinical atherosclerosis. This study suggests that middle aged men who are susceptible to COPD may also, be susceptible to vascular atherosclerosis by smoking, and atherosclerosis changes starts early in the disease process of COPD. Recommendations: We recommend more research studies on larger scale at different ages and in both sexes to understand the mechanism of atherosclerosis in COPD smokers and to identify an optimal treatment.