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Arterial Stiffness and Chronic Obstructive Pulmonary Disease/From the Authors

American Journal of Respiratory and Critical Care Medicine, Apr 15, 2008 by Boussuges, Alain, Gouitaa, Marion, Sabit, Ramsey, Bolton, Charlotte E, Cockcroft, John R, Shale, Dennis J

To the Editor:

In an article entitled ''Arterial Stiffness and Osteoporosis in Chronic Obstructive Pulmonary Disease,'' Dr. Sabit and colleagues found an increased arterial stiffness in patients with chronic obstructive pulmonary disease (COPD) (1). The increased aortic pulse wave velocity (PWV) was related to airflow obstruction, systemic inflammation, and the presence of osteoporosis. This study is particularly interesting, and we would like to submit some points for consideration. In Sabit and colleagues' study, heart rate (HR) was significantly increased in the COPD patients compared with the controls. Previous studies, as reviewed by Davies and Struthers (2), have shown that arterial compliance indices, such as PWV and augmentation index, are affected by HR. In these studies, an inverse relationship was observed between HR and the augmentation index, whereas a positive correlation was observed between HR and PWV. Consequently, caution must be exercised in the interpretation of Sabit and coworkers' results (1).

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Nevertheless, the results of Sabit and coworkers' study are supported by recent work performed by our team. In this study (3), significant decreases in total arterial compliance and brachial artery compliance were found in COPD patients in comparison with healthy subjects. Moreover, and consistent with Sabit and coworkers' results, the magnitude of changes in the peripheral circulation was related to the severity of COPD. Interestingly, an accelerated HR was also observed in our patients with COPD. Sympathetic hyperactivity could explain this significant HR increase. Indeed, previous work has demonstrated sympathetic activation in patients with chronic respiratory failure (4). Hypoxia, systemic inflammation, and obstruction of the bronchi have been incriminated. Sympathetic vascular smooth muscle activation promotes impairment in arterial compliance (5) and could contribute to the arterial stiffness found in patients with COPD.

Zureik and colleagues (6) found that impaired pulmonary function (restrictive or obstructive pulmonary disease) was associated with aortic stiffness in men. In that study, large artery compliance was measured by applanation tonometry to give a regional estimation of arterial compliance over the trunk (carotid to femoral).Aortic stiffness might have stemmed froman association between reduced lung function and atherosclerosis. Cigarette smoking, hypoxia, and systemic inflammation could be involved in the high incidence of atherosclerosis in COPD patients.

In total, several factors, such as atherosclerosis, sympathetic hyperactivity, and systemic inflammation, could participate in the alterations of the peripheral circulation in COPD patients. To reduce the cardiovascular risk and consequently to improve the prognosis of patients with COPD, these different factors should be taken into account.

Conflict of Interest Statement: Neither author has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

ALAIN BOUSSUGES

Université de la Méditerranée

Marseille, France

MARION GOUITAA

Assistance Publique des Hôpitaux

Marseille, France

References

1. Sabit R, Bolton CE, Edwards PH, Pettit RJ, Evans WD, McEniery CM, Wilkinson IB, Cockcroft JR, Shale DJ. Arterial stiffness and osteoporosis in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007;175:1259-1265.

2. Davies JI, Struthers AD. Pulse wave analysis and pulse wave velocity: a critical review of their strengths and weaknesses. J Hypertens 2003;21: 463-472.

3. Boussuges A, Rossi P, Gouitaa M, Nussbaum E. Alterations in the peripheral circulation in COPD patients. Clin Physiol Funct Imaging 2007;27:284-290.

4. Heindl S, Lehnert M, Criee CP, Hasenfuss G, Andreas S. Marked sympathetic activation in patients with chronic respiratory failure. Am J Respir Crit Care Med 2001;164:597-601.

5. Boutouyrie P, Locolley P, Girerd X, Beck L, Safar M, Laurent S. Sympathetic activation decreases medium-sized arterial compliance in humans. Am J Physiol 1994;267:H1368-H1376.

6. Zureik M, Benetos A, Neukirch C, Courbon D, Bean K, Thomas F, Ducimetière P. Reduced pulmonary function is associated with central arterial stiffness in men. Am J RespirCritCare Med 2001;164:2181-2185.

From the Authors:

We thankDrs. Boussuges andGouitaa for their interest in our article (1).Whilewe accept that heart rate (HR)was higher in patients with COPD compared with control subjects, we do not believe that this explains the difference in augmentation index (AIx) and aortic pulse wave velocity (PWV) between groups. We have previously shown thatHRinfluencesAIx(2),which iswhy inour study all valuesofAIx were corrected to 75 beats per minute. Additionally, HR was included as an independent variable in all stepwise regression models. The influence of HR on aortic PWV remains controversial, with a number of studies demonstrating no association (2, 3).

We read with interest the authors' reference to their article demonstrating reduced total arterial and brachial artery compliance in patients with COPD. While we welcome further support for our finding of increased arterial stiffness in patients with COPD, we caution against the use of brachial PWV. Unlike aorticPWV,which iswidely regardedas the gold standardmeasure of central arterial stiffness (4), brachial PWV to date has not been shown to be predictive of cardiovascular outcome (5).

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Arterial Stiffness and Chronic Obstructive Pulmonary Disease/From the Authors

American Journal of Respiratory and Critical Care Medicine, Apr 15, 2008 by Boussuges, Alain, Gouitaa, Marion, Sabit, Ramsey, Bolton, Charlotte E, Cockcroft, John R, Shale, Dennis J

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