Abstract: Background: 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 ultrasonography were done to all
subjects enrolled in the study. We determined Carotid intima- media thickness(IMT) and focal atheromatous plaques
as an indicator of subclinical atherosclerosis. Results: Our findings demonstrated that mean carotid intima-media
thickness 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 FEV1 (P=0.001) and between plaques and Log C- reactive protein levels (P=0.013)
independent 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. |
