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COPD as a risk factor for Coronary Artery Disease (CAD): Overview of 10-year atherosclerotic cardiovascular disease (ASCVD) risk assessment
(2022-12-01)
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Mickovski Ivana
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Baloski Marjan
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Doneva Daniela
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Neshovska Radmila
We aimed to investigate the association between COPD and CAD (overview of 10-year risk of fatal cardiovascularevent), and the relation to the severity of airflow limitation.Cross-sectional study including 220 patients with stable COPD as investigated group (IG), aged 40 to 75 yearsand 58 non-COPD subjects, matched by gender, age, BMI, smoking status, as control group (CG). All studysubjects underwent pulmonary, cardiological evaluation, lipid and glycemic status.The analysis compared the 10-year established ASCVD risk between COPD stages (according to GOLDclassification 1, 2, 3, 4) and between IG vs. CG. ASCVD score was classified as low (score <5%), borderline (5 to<7.5%), moderate (≥7.5 to <20) and high risk (score ≥20%). Results presented statistically significant differencebetween mean ASCVD value in IG 21,69±13,86% vs. CG 15,83±9,92% (p=0.0028). The median risk of ASCVDfor fatal cardiovascular events was high in IG and moderate in CG. The mean and median values of 10-yearASCVD risk in the IG subgroups were: GOLD1 16,79±8,04% (50% of the subjects with risk >15,7%), GOLD222,67±16,49% (50% of the subjects with risk >20,6%), GOLD3 26,81±14,15% (50% of the subjects with risk >27,6%) and GOLD4 20,70±13,52% (50% of the subjects with risk > 18,4%). The average ASCVD risk of fatalcardiovascular event was moderate in GOLD1 and GOLD4, and high in GOLD2 and GOLD3.We found higher risk for fatal cardiovascular outcome in patients with COPD, even in the early COPD stages(GOLD2), compared to non-COPD group. Our findings suggest that an urgent need to develop comprehensivestrategies for prevention, screening and early treatment are needed.
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COPD as a risk factor for carotid artery disease (CAD) and low-extremity artery disease (LEAD)
(European Respiratory Society, 2020-09-07)
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Kochovska Kamchevska, Nade
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Baloski, Marjan
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Poposki, Bozidar
We aimed to investigate the association between COPD and peripheral artery disease (PAD), the relation to the severity of airflow limitation and the level of serum C-reactive protein (CRP). Cross-sectional study including 120 patients with initially diagnosed COPD, aged 40 to 75 years and 60 non-COPD subjects matched by age, smoking status, body mass index, as controls. All study participants underwent pulmonary evaluation (dyspnea severity assessment, baseline and post-bronchodilator spirometry, gas analyses, chest X-ray), Doppler ultrasonography and measurement of serum CRP. Results presented statistically significant difference in presence of LEAD in COPD patients compared to controls (78.3% vs 38.3%; P<0.001). According to the Fontaine classification, COPD patients with LEAD were categorized in stages I, IIA and IIB (60%, 30% and 15%, respectively), whereas all controls with LEAD were in the Fontaine stage I. COPD patients with LEAD presented significant association between disease severity and clinical manifestations due to the vascular changes (P=0.001) and CRP (P<0.05). Comparison between presence of CAD in COPD and controls showed statistical significance (70% vs 36%; P < 0.0001). The mean value of intima-media thickness (IMT) in COPD patients with CAD was significantly higher than its mean value in controls (0.8 ± 0.2 vs. 0.6 ± 0.1; P=0.0043). IMT value in COPD patients with CAD was significantly related to FEV1 decline (P=0.000) and CRP (P=0.001). We found higher prevalence and severity of PAD in COPD patients compared to non-COPD and significant relation to FEV1 decline and serum CRP. Our findings suggest a need for early screening for PAD in COPD and an integrated-care approach.
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Evaluation of IL-8 and MEF25-75 in patients with severe COPD who were treated with combined therapy of ICSs / LABAs plus tiotropium bromide
(Europian Respiratory Society, 2013)
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Zlatica Gosheva
;
Angelko Gjorchev
;
Suzana Arbutina
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The aim of this study was to determine the effect of combined therapy of ICSs/LABAs plus tiotropiumbromide in patients with COPD, by analyzing of IL-8 and MEF25-75 at the beginning and after 6 months oftherapy. The study included 33 patients with severe COPD. In each of them were measured serum IL-8levels by the ELISA method and MEF25-75 which are indicated the small airways obstruction. They weretreated with combined therapy of ICSs/LABAs (500mcg) plus Tiotropium Bromide (18mcg) daily in durationof 6 months. The results were statistically elaborated according to the T-test for Dependent Samples. Theobtained results of IL-8 showed that the level of IL-8 before the start of therapy were much higher and thattreatment significantly reduces their value (t=3.13, p=0.003, p<0.05). The results of MEF 25-75 at the startof therapy were lower and after 6 months of treatment showed a slight improvement of lung function butstatistically insignificant (t= -0.83, p=0.41,p<0.05). The concentration of IL-8 is closely related with airwayobstruction in patients with COPD and may serve as a marker for evaluating the severity of airwayinflammation. ICSs/LABAs and tiotropium bromide have inhibitory effect on neutrophilic inflammationthrough the suppression of IL-8 production from epithelial cells and thus may contribute to lower cellularinflammation in COPD. Because it is a progressive disease and airflow limitation is not fully reversible, wecannot expect spectacular results like we show with the value of MEF25-75, but should strive to preventprogression and reduce airway remodeling with education, pharmacologic and non pharmacologic treatment

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