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Does Chronic Obstructive Pulmonary Disease Cause Cardiovascular Disease?

See related article, pp 499–506 

In this issue of Hypertension , Fisk et al1 attempt to dissect the intrinsic contribution of chronic obstructive pulmonary disease (COPD) to augmented risk of cardiovascular disease. Presence of common risk factors, notably smoking, and other confounders makes this an ambitious exercise. Data from 2 observational cohorts were studied in a case–control design in subjects who had undergone investigations of key surrogate markers of cardiovascular risk, namely, subclinical atherosclerosis (carotid intima–media thickness) and arteriosclerosis (arterial stiffness measures based on aortic pulse wave velocity and augmentation index).

Patients with COPD and confirmatory spirometry were aged ≥40 years, with ≥10 pack-years of smoking and free of exacerbations in the preceding 4 weeks before study entry. Control patients were matched on the basis of age, sex, and body mass index. As expected in such studies, there were multiple demographic factors that were significantly different between the 2 groups: angina, myocardial infarction, stroke, and peripheral vascular disease and diabetes mellitus were all more common in the COPD cohort, as was therapy for hypercholesterolemia. The latter may explain the slightly lower mean low-density lipoprotein cholesterol in the COPD group compared with control subjects, but the mean value in the patients with COPD was still high (3.00 mmol/L), suggesting undertreatment. These findings were concordant with the higher carotid intima–media thickness values in patients with COPD. Similarly, although there was no difference in antihypertensive therapy, systolic blood pressure (mean, 145 mm Hg) and pulse …