In patients with chronic obstructive pulmonary disease (COPD) with or at high risk for cardiovascular disease (CVD), baseline arterial pulse wave velocity (aPWV) appears to be predictive of mortality but is unaffected by therapy, according to the results of a multicenter randomized double-blind study published in the American Journal of Respiratory and Critical Care Medicine.
Patients with COPD are at an increased risk for CVD and aPWV is a vascular stiffness marker that is an independent predictor of this risk in these patients. Previous studies, however, showed inconclusive results on whether inhaled therapies for COPD reduce aPWV, most likely due to small sample sizes.
Thus, researchers conducted the Study to Understand Mortality and Morbidity in COPD (SUMMIT) trial in a large patient population (n=16,485) with moderate COPD who had or were at high risk for CVD to determine whether aPWV would predict mortality and whether inhaled therapy would affect aPWV and several additional metrics of arterial stiffness.
The findings revealed that baseline aPWV appeared predictive of mortality but was unaffected by therapy. Moreover, there was no treatment effect on PWA parameters (central augmentation pressure, central augmentation pressure at heart rate of 75 bpm, or central systolic blood pressure). When aPWV was presented in quartiles, the probability of mortality increased relative to baseline aPWV. Patients in the highest quartile group (aPWV >10.7 m/s) had a 90% increase in risk for death vs the lowest quartile group (aPWV ≤7.4 m/s).
This analysis adds to and confirms previous studies that evaluated the effect of treating COPD with comorbid cardiovascular complications. Because smoking is a common risk factor for both COPD and CVD, future studies investigating smoking-induced inflammation are needed to identify potential pathogenetic links between COPD and CVD, which could lead to the development of novel therapies.
The investigators concluded, “The cumulative data suggest that despite the increased prevalence and importance of CVD in patients with COPD, aggressive treatment focusing on improving CVD risk factors is paramount, as inhaled therapy for COPD appears unlikely to reduce the associated heightened CV risk.”
Disclosure: This clinical trial was supported by GlaxoSmithKline plc Please see the original reference for a full list of authors’ disclosures.
Crim C, Anderson JA, Calverley PMA, et al. Pulse wave velocity in chronic obstructive pulmonary disease and the impact of inhaled therapy (SUMMIT): A randomized double-blind clinical trial [published online February 4, 2020]. Am J Respir Crit Care Med. doi:10.1164/rccm.201908-1639LE