Pneumologie 2016; 70 - P297
DOI: 10.1055/s-0036-1572094

High prevalence of peripheral arterial disease in chronic obstructive pulmonary disease

C Pizarro 1, F Linnhoff 1, C Schäfer 1, N Schahab 1, G Nickenig 1, D Skowasch 1
  • 1Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn

Background: In view of their overlapping risk factors and the chronic inflammatory processes that underlie onset and progression of both chronic obstructive pulmonary disease (COPD) and arteriosclerotic disorders, the occurrence of peripheral arterial disease (PAD) in COPD is conceivable but undefined.

Methods: We screened 108 patients with COPD for PAD. Standardized angiological testing comprehended determination of ankle brachial index (ABI), measurement of pulse wave index (PWI) and central pulse wave velocity (cPWV) as well as duplex sonography.

Results: Study population was late middle-aged (64.8 ± 10.4years) with a slight male overweight (53.7%). Percentaged GOLD stages distribution was 13.9%, 40.7%, 9.3% and 36.1% for GOLD stage A, B, C and D, respectively. Mean FEV1 and RV accounted for 56.7 ± 21.8% and 173.9 ± 69.4% predicted. 67.6% were current or former smokers (mean: 38.2 pack-years); alpha 1 antitrypsin deficiency was present in 5/108 patients (4,6%).

Angiological testing revealed PAD prevalence in 82 out of 108 patients (75.9%): 55.5% of patients were found to be in Fontaine stage I, 13.0% were in Fontaine stage IIa and 7.4% in Fontaine stage IIb. Mean calculated ABI averaged 1.01 (range: 0.33 – 1.92) for the right and accordingly 1.03 (range: 0.54 – 1.60) for the left leg. Pulse volume recording evinced bilaterally concordant mean pulse wave indices (right leg: 290.9, left leg: 227.8). Mean cPWV averaged 7.2 m/s (2.2 – 21.6 m/s) and thus lay within normal range.

Distribution analysis of Fontaine groups within GOLD stages exhibited significant association (p = 0.003). Simultaneously, both ABI (p = 0.02, Speaman's rho: -0.25) and PWI (p = 0.04, Spearman's rho: 0.24) correlated significantly with COPD GOLD severity stages.

Discussion: Among COPD patients, the prevalence of PAD was identified to be unexpectedly high (75.9%). PAD stages, ABI and PWI evinced significant distributive differences over COPD GOLD stages. It points at a substantial PAD under-diagnosis and under-treatment in daily clinical treatment of COPD.