ROTTERDAM, THE NETHERLANDS – Older patients with chronic obstructive pulmonary disease are at increased risk for carotid artery plaque formation and for the presence of vulnerable plaques with a lipid core, according to a new study from researchers in the Netherlands.
“We know that chronic obstructive pulmonary disease is a risk factor for ischemic stroke, and that certain components of carotid artery plaques such as intraplaque hemorrhage and lipid core increase the risk of ischemic events, but plaque composition in patients with chronic obstructive pulmonary disease has not been examined,” said researcher Bruno H.C. Stricker, MD, PhD, professor of pharmaco-epidemiology at the Erasmus Medical Center in Rotterdam, the Netherlands. “In our study, carotid artery wall thickening was increased twofold in older chronic obstructive pulmonary disease patients compared with controls with normal lung function, and chronic obstructive pulmonary disease was an independent predictor of the presence of plaques with a lipid core, which are more prone to rupture.”
The findings were published online in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.
The cross-sectional study, part of the Rotterdam Study, an ongoing population-based cohort study examining the occurrence of and risk factors for chronic diseases in subjects aged 55 years and older, involved 253 chronic obstructive pulmonary disease patients and 920 controls. Chronic obstructive pulmonary disease was confirmed by spirometry. Subjects with carotid wall thickening (intima-media thickness ≥ 2.5 mm) on ultrasonography underwent high-resolution magnetic resonance imaging (MRI) to characterize carotid plaques.
Subjects with chronic obstructive pulmonary disease had a twofold increased risk (odds ratio 2.0, 95%CI 1.44-2.85, p < 0.0001) of carotid wall thickening on ultrasonography compared to controls, and this risk increased significantly with the severity of airflow limitation. On MRI, vulnerable lipid core plaques were significantly more frequent in subjects with chronic obstructive pulmonary disease compared with controls (odds ratio 2.1, 95%CI 1.25-3.69, p=0.0058).
“Clinicians should be aware that chronic obstructive pulmonary disease patients are at increased risk for asymptomatic carotid atherosclerosis and that chronic obstructive pulmonary disease might lead to vulnerable plaques by inducing or aggravating the presence of plaques with a lipid core,” said Dr. Stricker.
The study had a few limitations, including the study’s cross-sectional design, which doesn’t allow causal associations between chronic obstructive pulmonary disease and carotid plaques to be inferred, and the lack of computed tomography confirmation of emphysema
“The results of our study provide new insights into the relationship between chronic obstructive pulmonary disease and the increased risk for stroke seen in these patients,” concluded Dr. Stricker. “Understanding the underlying risk factors for stroke in chronic obstructive pulmonary disease patients can help identify those at high risk and lead to the development of more personalized preventive treatment strategies targeting this devastating complication.”
- MFP Wire Services