Background
Exacerbations are linked to cardiovascular risk in COPD: cardiovascular events occur more often during exacerbation1 and in frequent exacerbators2. Increased levels of inflammation could be implicated in this.
Aims
To determine if frequent exacerbation (?2/year) or markers of inflammation are linked to coronary artery disease (CAD) in COPD.
Methods
50 subjects from the London COPD Exacerbation Cohort underwent CT coronary angiogram (CTCA), CT thorax, spirometry, systemic inflammatory markers and sputum culture at baseline. Participants with obstructive CAD on CTCA (?50% stenosis in ?1 epicardial vessel) were compared to those with non-obstructive/no CAD (<50% stenosis/no CAD).
Results
Of those with obstructive CAD, 35% were frequent exacerbators. Of those without obstructive CAD, 59% were frequent exacerbators (P=0.1, chi-square test). Obstructive CAD was associated with increased plasma fibrinogen levels (3.7g/L versus 3.3g/L, P=0.02, unpaired t-test) and higher rates of sputum bacterial growth (?2 cultures positive for same bacteria at baseline) (30% versus 7%; P=0.05, Fisher?s exact test). When correcting for age, sex, FEV1 and smoking, plasma fibrinogen (P=0.03, linear regression), CT evidence of bronchial wall thickening (P=0.05, logistic regression) and sputum bacterial growth (P=0.05, logistic regression) were associated with obstructive CAD.
Conclusions
Obstructive CAD was not related to exacerbation frequency in patients with COPD, but was related to plasma fibrinogen, bronchial wall thickening and sputum bacteria, indicating a possible role for inflammation in the relationship between COPD and cardiovascular risk.
1.Kunisaki, K.M. et al. AJRCCM 2018;198(1):51-7
2.Donaldson, G.C. et al. Chest 2010;137(5):1091-7