title: Subclinical cardiovascular disease in patients with chronic obstructive pulmonary disease: a systematic review.
abstract: BACKGROUND
  Cardiovascular disease (CVD) accounts for a significant portion of deaths in patients with COPD; however, evidence for early detection strategies for CVD in this population remain limited. Our paper aims to summarize existing data regarding subclinical CVD in patients with COPD with a view to identifying screening strategies in these patients.
  
  
  METHODS
  A systematic review of published literature was conducted for studies examining the relationship of COPD and markers of subclinical disease such as coronary artery calcification (CAC), carotid intima media thickness (cIMT), endothelial dysfunction, arterial stiffness as measured by pulse wave velocity (PWV) and augmentation indices (AIx). Both MEDLINE and EMBASE databases were searched till October 2015.
  
  
  RESULTS
  A total of 22 studies were included in the review. Compared with control subjects, patients with COPD had significantly higher cIMT (SMD 0.53, 95% CI 0.16-0.90), PWV (SMD 0.91, 95% CI 0.67-1.16) and AIx (SMD 0.86, 95% CI 0.52-1.19). Additionally, an overall higher prevalence of subclinical CVD as assessed by CAC, ABI and FMD was noted in our review.
  
  
  CONCLUSIONS
  Although our findings need further evaluation in prospective studies, our review presents significant evidence in support of increased subclinical CVD burden in COPD patients independent of smoking status. Further large-scale case-control studies are required to highlight the significance of subclinical CVD screening in COPD patients.
authors.affiliation: From the Baptist Health South Florida, Center for Healthcare Advancement and Outcomes, 1691 Michigan Avenue Suite 500; Miami Beach, FL 33139, USA.|Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, USA.
authors.forename: C
authors.initials: C
authors.lastname: Ye
authors.affiliation: From the Baptist Health South Florida, Center for Healthcare Advancement and Outcomes, 1691 Michigan Avenue Suite 500; Miami Beach, FL 33139, USA.
authors.forename: A
authors.initials: A
authors.lastname: Younus
authors.affiliation: From the Baptist Health South Florida, Center for Healthcare Advancement and Outcomes, 1691 Michigan Avenue Suite 500; Miami Beach, FL 33139, USA.
authors.forename: R
authors.initials: R
authors.lastname: Malik
authors.affiliation: From the Baptist Health South Florida, Center for Healthcare Advancement and Outcomes, 1691 Michigan Avenue Suite 500; Miami Beach, FL 33139, USA.
authors.forename: L
authors.initials: L
authors.lastname: Roberson
authors.affiliation: From the Baptist Health South Florida, Center for Healthcare Advancement and Outcomes, 1691 Michigan Avenue Suite 500; Miami Beach, FL 33139, USA.|Aventura Hospital and Medical Center, 20900 Biscayne Blvd, Aventura, FL 33180, USA.
authors.forename: S
authors.initials: S
authors.lastname: Shaharyar
authors.affiliation: From the Baptist Health South Florida, Center for Healthcare Advancement and Outcomes, 1691 Michigan Avenue Suite 500; Miami Beach, FL 33139, USA.
authors.forename: E
authors.initials: E
authors.lastname: Veledar
authors.affiliation: From the Baptist Health South Florida, Center for Healthcare Advancement and Outcomes, 1691 Michigan Avenue Suite 500; Miami Beach, FL 33139, USA.
authors.forename: R
authors.initials: R
authors.lastname: Ahmad
authors.affiliation: From the Baptist Health South Florida, Center for Healthcare Advancement and Outcomes, 1691 Michigan Avenue Suite 500; Miami Beach, FL 33139, USA.|University of Manchester School of Medicine, Stopford Building, Oxford Road, Manchester M13 9PT, UK.
authors.forename: S S
authors.initials: SS
authors.lastname: Ali
authors.affiliation: From the Baptist Health South Florida, Center for Healthcare Advancement and Outcomes, 1691 Michigan Avenue Suite 500; Miami Beach, FL 33139, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Latif
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, 1240 S.W. 108 AVE, Path, University Park, Miami, FL 33174, USA.
authors.forename: W
authors.initials: W
authors.lastname: Maziak
authors.affiliation: Aventura Hospital and Medical Center, 20900 Biscayne Blvd, Aventura, FL 33180, USA.
authors.forename: H
authors.initials: H
authors.lastname: Feiz
authors.affiliation: From the Baptist Health South Florida, Center for Healthcare Advancement and Outcomes, 1691 Michigan Avenue Suite 500; Miami Beach, FL 33139, USA.|Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, 1240 S.W. 108 AVE, Path, University Park, Miami, FL 33174, USA.|Department of Internal Medicine, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL 33140, USA.
authors.forename: E
authors.initials: E
authors.lastname: Aneni
authors.affiliation: From the Baptist Health South Florida, Center for Healthcare Advancement and Outcomes, 1691 Michigan Avenue Suite 500; Miami Beach, FL 33139, USA.|University of Manchester School of Medicine, Stopford Building, Oxford Road, Manchester M13 9PT, UK.|Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, 1240 S.W. 108 AVE, Path, University Park, Miami, FL 33174, USA.|Herbert Wertheim College of Medicine, Florida International University, 11200 Southwest 8th Street, Miami, FL 33199, USA.|Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Johns Hopkins University, 1800 Orleans St, Baltimore, MD 21287, USA.
authors.forename: K
authors.initials: K
authors.lastname: Nasir
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D059168:Carotid Intima-Media Thickness; D006801:Humans; D008403:Mass Screening / Q000379:methods; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000453:epidemiology; D063177:Pulse Wave Analysis