title: Cardiovascular risk, myocardial injury, and exacerbations of chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Patients with chronic obstructive pulmonary disease (COPD) have elevated cardiovascular risk, and myocardial injury is common during severe exacerbations. Little is known about the prevalence, magnitude, and underlying mechanisms of cardiovascular risk in community-treated exacerbations.
  
  
  OBJECTIVE
  To investigate how COPD exacerbations and exacerbation frequency impact cardiovascular risk and myocardial injury, and whether this is related to airway infection and inflammation.
  
  
  METHODS
  We prospectively measured arterial stiffness (aortic pulse wave velocity [aPWV]) and cardiac biomarkers in 98 patients with stable COPD. Fifty-five patients had paired stable and exacerbation assessments, repeated at Days 3, 7, 14, and 35 during recovery. Airway infection was identified using polymerase chain reaction.
  
  
  RESULTS
  COPD exacerbation frequency was related to stable-state arterial stiffness (rho = 0.209; P = 0.040). Frequent exacerbators had greater aPWV than infrequent exacerbators (mean ± SD aPWV, 11.4 ± 2.1 vs. 10.3 ± 2.0 ms(-1); P = 0.025). Arterial stiffness rose by an average of 1.2 ms(-1) (11.1%) from stable state to exacerbation (n = 55) and fell slowly during recovery. In those with airway infection at exacerbation (n = 24) this rise was greater (1.4 ± 1.6 vs. 0.7 ± 1.3 ms(-1); P = 0.048); prolonged; and related to sputum IL-6 (rho = 0.753; P < 0.001). Increases in cardiac biomarkers at exacerbation were higher in those with ischemic heart disease (n = 12) than those without (n = 43) (mean ± SD increase in troponin T, 0.011 ± 0.009 vs. 0.003 ± 0.006 μg/L, P = 0.003; N-terminal pro-brain natriuretic peptide, 38.1 ± 37.7 vs. 5.9 ± 12.3 pg/ml, P < 0.001).
  
  
  CONCLUSIONS
  Frequent COPD exacerbators have greater arterial stiffness than infrequent exacerbators. Arterial stiffness rises acutely during COPD exacerbations, particularly with airway infection. Increases in arterial stiffness are related to inflammation, and are slow to recover. Myocardial injury is common and clinically significant during COPD exacerbations, particularly in those with underlying ischemic heart disease.
authors.affiliation: 1 UCL Respiratory Medicine, University College London, Royal Free Campus, Rowland Hill Street, London, United Kingdom.
authors.forename: Anant R C
authors.initials: AR
authors.lastname: Patel
authors.forename: Beverly S
authors.initials: BS
authors.lastname: Kowlessar
authors.forename: Gavin C
authors.initials: GC
authors.lastname: Donaldson
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mackay
authors.forename: Richa
authors.initials: R
authors.lastname: Singh
authors.forename: Siobhan N
authors.initials: SN
authors.lastname: George
authors.forename: Davinder S
authors.initials: DS
authors.lastname: Garcha
authors.forename: Jadwiga A
authors.initials: JA
authors.lastname: Wedzicha
authors.forename: John R
authors.initials: JR
authors.lastname: Hurst
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000503:physiopathology; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism; D009202:Cardiomyopathies / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000150:complications*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006339:Heart Rate; D006801:Humans; D015850:Interleukin-6 / Q000032:analysis; D016209:Interleukin-8 / Q000032:analysis; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D063177:Pulse Wave Analysis; D012307:Risk Factors; D013147:Spirometry; D013183:Sputum / Q000737:chemistry; D020107:Troponin T / Q000097:blood; D059289:Vascular Stiffness
chemical_list: C508606:CXCL8 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6; D016209:Interleukin-8; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D005340:Fibrinogen; D002097:C-Reactive Protein
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