COPD linked to small vessel disease
By Kirsty Oswald, medwireNews Reporter
25 July 2013
Am J Respir Crit Care Med 2013; Advance online publication

medwireNews: Researchers have found that chronic obstructive pulmonary disease (COPD) is an independent risk factor for cerebral microbleeds, suggesting that the condition has effects on both large and small blood vessels.

The team, reporting in the American Journal of Respiratory and Critical Care Medicine, says that given the association between cerebral small vessel disease and cognitive decline, the findings indicate a need for preventive strategies for patients with COPD.

COPD was associated with both prevalent and incident microbleeds, the researchers report. The cross-sectional component of the study included 165 participants with COPD and 645 participants without from the Rotterdam study, who underwent magnetic resonance imaging at a single time point.

Overall, 44.8% of COPD patients had cerebral microbleeds, significantly more than the 31.3% of healthy participants. After adjustment for confounding factors, this equated to a 70% increased odds for microbleeds in COPD patients.

In particular, COPD was significantly associated with a 3.3-fold increased risk for deep or infratentorial microbleeds, indicative of arteriolosclerotic microangiopathy.

Notably, the authors found that the prevalence of microbleeds in COPD patients who had ever smoked was significantly higher than in non-COPD participants who had smoked (47.8 vs 32.8%), suggesting that smoking alone could not explain the results.

“These results are in line with previous findings that oxidative stress persists in patients with COPD despite smoking cessation, and has a crucial role in the perpetuation of the inflammation,” Bruno Stricker (Erasmus Medical Center, Rotterdam, the Netherlands) and colleagues write.

They also report that microbleeds were more common in patients with more severe airflow restriction, those with more frequent exacerbations, and those with greater emphysema.

The researchers also performed a longitudinal analysis involving 46 patients with COPD and 507 participants without COPD who had no microbleeds at baseline. Over a median follow up of 3.4 years, 10.9% of patients with COPD developed a deep or infratentorial microbleed compared with just 2.6% of participants without COPD, translating to a 7.1-fold increased odds.

“Given the importance of cognitive and functional consequences, our results might lead to a better recognition of vulnerable patient groups, and enhance research into necessary preventive strategies,” the authors conclude.

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

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