title: Determinants of arterial stiffness in COPD.
abstract: BACKGROUND
  Cardiovascular morbidity and mortality is high in patients with chronic obstructive pulmonary disease (COPD) and arterial stiffness is a potentially modifiable risk factor with added predictive value beyond that obtained from traditional risk factors. Arterial stiffness has been the target of pharmacologic and exercise interventions in patients with COPD, but the effects appear limited to those patients with more significant elevations in arterial stiffness. We aimed to identify predictors of increased arterial stiffness in a cohort with moderate to severe COPD.
  
  
  METHODS
  Aortic pulse wave velocity (aPWV) was measured in subjects with moderate to severe COPD enrolled in a multicenter randomized controlled trial. Subjects were categorized into quartiles based on aPWV values and factors affecting high arterial stiffness were assessed. Multivariate models were created to identify independent predictors of high aPWV, and cardiovascular disease (CVD).
  
  
  RESULTS
  153 patients were included. Mean age was 63.2 (SD 8.2) years and mean FEV1 was 55.4 (SD 15.2) % predicted. Compared to the quartile with the lowest aPWV, subjects in the highest quartile were older, had higher systolic blood pressure (SBP), were more likely to be current smokers, and had greater burden of thoracic aortic calcification. On multivariate analyses, age (adjusted OR 1.14, 95%CI 1.05 to 1.25, p = 0.003) and SBP (adjusted OR 1.06, 95% CI 1.02 to 1.09, p = 0.001) were independent predictors of elevated aPWV. Body mass index, therapy with cholesterol lowering medications and coronary calcification were independent predictors of CVD.
  
  
  CONCLUSIONS
  Elevated arterial stiffness in patients with COPD can be predicted using age, blood pressure and thoracic aortic calcification. This will help identify subjects for enrollment in clinical trials using aPWV for assessing the impact of COPD therapies on CV outcomes.
authors.affiliation: Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, UK. spbhatt@uab.edu.
authors.forename: Surya P
authors.initials: SP
authors.lastname: Bhatt
authors.forename: Adam G
authors.initials: AG
authors.lastname: Cole
authors.forename: James Michael
authors.initials: JM
authors.lastname: Wells
authors.forename: Hrudaya
authors.initials: H
authors.lastname: Nath
authors.forename: Jubal R
authors.initials: JR
authors.lastname: Watts
authors.forename: John R
authors.initials: JR
authors.lastname: Cockcroft
authors.forename: Mark T
authors.initials: MT
authors.lastname: Dransfield
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology*; D012307:Risk Factors; D012720:Severity of Illness Index; D059289:Vascular Stiffness