Association of COPD with carotid wall intima-media thickness in vascular surgery patients.
BACKGROUND
There is increasing evidence that non-invasive imaging modalities such as ultrasonography may be able to detect subclinical atherosclerotic lesions, and as such may be useful tools for risk-stratification. However, the clinical relevance of these observations remains unknown in patients with COPD. Therefore we investigated the association between COPD and carotid wall intima-media thickness (IMT) in patients undergoing vascular surgery and its relationship with mortality in these patients.


METHODS
Carotid wall IMT was measured in 585 patients who underwent lower extremity, aortic aneurysm or stenosis repair. Primary study endpoint was increased carotid wall IMT which was defined as IMT>or=1.25mm. Secondary study endpoints included total and cardiovascular mortality over a mean follow-up of 1.5 years.


RESULTS
Thirty-two percent of patients with mild COPD and 36% of the patients with moderate/severe COPD had increased carotid wall IMT, while only 23% had an increased carotid wall IMT in patients without COPD (p<0.01). COPD was independently associated with an increased carotid wall IMT (OR 1.60; 95% CI 1.08-2.36). Among patients with COPD, increased carotid wall IMT was associated with an increased risk of total (HR, 3.18 95% CI 1.93-5.24) and cardiovascular mortality (HR 7.28, 95% CI 3.76-14.07).


CONCLUSIONS
COPD is associated with increased carotid wall IMT independent of age and smoking status. Increased carotid wall IMT is associated with increased total and cardiovascular mortality in patients with COPD suggesting that carotid wall measurements may be a good biomarker for morbidity and mortality in these patients.
van Gestel
Yvette R B M
YR
Department of Anesthesiology, Erasmus Medical Center, 's-Gravendijkwal 230, Rotterdam, The Netherlands.
Flu
Willem-Jan
WJ
van Kuijk
Jan-Peter
JP
Hoeks
Sanne E
SE
Bax
Jeroen J
JJ
Sin
Don D
DD
Poldermans
Don
D
D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality / Q000473:pathology*; D002339:Carotid Arteries / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality / Q000473:pathology*; D012307:Risk Factors; D017539:Tunica Intima / Q000473:pathology*; D017540:Tunica Media / Q000473:pathology*; D014656:Vascular Surgical Procedures