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2. Is COPD a risk factor for increased arterial stiffness? Julie Hjortsø Janner Dept. of Cardiology and Respiratory Medicine Hvidovre University Hospital Copenhagen, Denmark Conflicts of Interest: None

3. COPD and CVD High risk of CVD is a consequence of COPD? Arterial stiffness predicts CVD Measurements of arterial stiffness: –Pulse wave velocity - PWV –Augmentation index – AIx

4. Pulse pressure (PP) Augmentation pressure (AP) Systolic pressure Diastolic pressure Pulse wave analysis AIx75 = AP / PP (corrected for heart rate)

5. COPD and arterial stiffness PWV, AIx and augmentation pressure are increased in patients with COPD R. Sabit et al. Am J Respir Crit Care Med 2007;175:1259-1265 NL. Mills et al. Thorax 2008;63:306-311 PWV is increasing with emphysema severity in patients with COPD D. McAllister et al. Am J Respir Crit Care Med 2007;176:1208-1214 Conflicting results regarding PWV association with FEV 1 in the general population M. Zureik et al. Am J Respir Crit Care Med 2001;164:2181-2185 K.Taneda et al. Clin Exp Pharmacol Physiol 2004;31:S31-S34

6. Hypothesis - Objective Decrease in lung function is associated with increase in AIx75 Examine the association between COPD, lung function (FEV 1, FVC) and arterial stiffness measured by AIx75

7. Methods Copenhagen City Heart Study – 6300 subjects COPD: –FEV 1 /FVC < 70 % –Age > 40 years –No astma 849 subjects with COPD 550 subjects with COPD (moderate to severe) and measurements of AIx75

8. AIx75 - COPD COPDNo COPDP-value Men24.4718.49< 0.001 Women30.7126.48< 0.001 AIx75 GOLD 1GOLD 2GOLD 3+4P-value Men24.3024.4724.93NS Women29.6831.4230.71NS AIx75

9. AIx75 – COPD: linear regression model Crude Effect Of COPD

10. AIx75 – COPD: linear regression model Crude Model 1 Model 2 Crude Model 1 Model 2 Partly adjusted Crude Effect Of COPD Partly adjusted

11. AIx75 – COPD: linear regression model Crude Effect Of COPD Partly adjusted Fully adjusted

12. AIx75 – FEV 1 : Generalised additive model Men AIx75 (Diff. from mean) FEV1 (L/min)

13. AIx75 – FEV 1 : Generalised additive model Men AIx75 (Diff. from mean) FEV1 (L/min) Women

14. Conclusion COPD is NOT associated with AIx75 after controlling for confounders This could be due to: – No association of arterial stiffness and COPD –AIx75 is an inadequate measurement of arterial stiffness in subjects with COPD

15. Thank you for your attention The work has been done in cooperation with: –NS. Godtfredsen – Dept. of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark –E. Prescott – Dept. of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark –D. McAllister – ELEGI/Colt Laboratories, MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom –J. Vestbo – Dept. of Cardiology and Respiratory Medicine, Hvidovre University Hospital, Hvidovre, Denmark Funding: –The Danish Lung Association –The Danish Heart Foundation (08-4-R64-A1992-B808-22466) –The Danish Cardiovascular Research Academy (DaCRA). –ERS (Short-term fellowship)