Cardiac Remodeling and Subclinical Atherosclerosis in Early Stage Copd: Possible Role of Oxidative Sterss and Inflammation

Background: The high prevalence of cardiovascular (CV) disease in advanced COPD is not only due to the shared traditional risk factors, being oxidative stress and inflammation emerging pathogenetic actors. However, little is known in the early stages of COPD.
Aims: To assess CV organ damage in mild-moderate COPD with regard to Left Ventricular Mass (LVM), Carotid Intima-Media Thickness (CIMT), Ankle-Brachial Index (ABI) and to evaluate the association with oxidative stress and inflammatory markers.
Methods: 47 ex-smokers, aged 60-85y, mild-moderate COPD outpatients were age-, sex-, smoking habit- matched with 51 non-COPD controls.
A clinical evaluation, blood sampling and functional tests (spirometry, echocardiography, echo-color-doppler, ABI measurement) were performed.
Results: In COPD, compared to non-COPD we found: similar prevalence of hypertension, dyslipidemia and diabetes, while blood pressure and cholesterol levels were lower. Moreover LVM (with a 38% prevalence of LV hypertrophy) and CIMT were significantly increased, while ABI was decreased. Systemic markers of inflammation (high-sensitive C reactive protein, hs-CRP, white blood cells, WBC) and of oxidative stress (malondialdehyde, MDA) were significantly higher; on the contrary, the antioxidant glutathione (GSH) was significantly lower. A positive association between LVM and hs-CRP, WBC and MDA and a negative one with GSH were found. Finally, our results show an inverse correlation between FEV1 and LVM.
Conclusions: Cardiac remodeling and subclinical atherosclerosis are present in mild-moderate COPD patients with optimal control of CV risk factors. This may be related to a persistent low-grade of inflammation and oxidative stress.