Letter to the editor Herz 2014 DOI 10.1007/s00059-013-3977-x © Urban & Vogel 2014
Comment on Aykan AC, Gökdeniz T, Boyacı F et al (2013) Assessment of arterial stiffness in chronic obstructive pulmonary disease by a novel method: cardio-ankle vascular index. Herz. doi:10.1007/s00059-013-3902-3
To the Editor We read the article “Assessment of arterial stiffness in chronic obstructive pulmonary disease by a novel method” with great interest . The authors concluded that increased arterial stiffness assessed via the cardio-ankle vascular index (CAVI) is associated with the spirometric severity of chronic obstructive pulmonary disease (COPD). Arterial stiffness represents the viscoelastic properties of the vessel wall. Increased arterial stiffness is an indicator of coronary artery disease, cerebrovascular disease, and peripheral arterial disease. Additionally, some conditions like hypertension, smoking, hypercholesterolemia, diabetes mellitus, gastrointestinal diseases, aging, and systemic inflammatory diseases such as psoriasis increase arterial stiffness parameters . Furthermore, certain medications such as antihypertensive treatment including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and statins may influence arterial stiffness parameters. In previous studies, the authors investigated the relationship between arterial stiffness and blood markers. Serum calcium levels were found to be related to arterial stiffness and significantly associated with arterial stiffness parameters. Furthermore, a significant relationship has been shown between central aortic pressure and serum vitamin B12 and phospho-
S. Balta · A.Ç. Aykan
Arterial stiffness in chronic obstructive pulmonary disease rus levels. In addition, augmentation indexes had a significant correlation with albumin and magnesium levels . Arterial stiffness is a noninvasive method for assessing endothelial dysfunction in clinical practice, but without other inflammatory markers, arterial stiffness alone might not provide information to clinicians about inflammation in COPD patients. It would have been better if these factors were included in the paper.
Corresponding address Sevket Balta, MD Department of Cardiology Gulhane School of Medicine Tevfik Saglam St. 06018 Etlik, Ankara Turkey [email protected]
Compliance with ethical guidelines Conflict of interest. S. Balta states that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.
Reply A.Ç. Aykan Thank you for your suggestions. Contrary to other methods of arterial stiffness measurement, CAVI reflects the stiffness of the entire arterial tree including the aorta and the brachial and tibial arteries; it is not influenced by blood pressure levels and can be accurately measured in older patients. Data on the association between CAVI and serum albumin, magnesium, and vitamin B12 levels are lacking in the literature. These parameters were initially not considered in our study. Furthermore, we stated in the limitations section that laboratory examinations including highsensitive C-reactive protein, von Willebrand factor, blood gas analysis, and assessment of endothelial dysfunction may add additional information. COPD is a systemic disease and cardiovascular disease (CVD) constitutes the leading cause of death in patients with COPD. Maclay et al. have shown the presence of vascular dysfunction in patients with COPD, and it was attributed to increased arterial stiffness rather than systemic endothelial dysfunction . We found that with increasing stages of COPD, CAVI was increased. The mechanistic link between COPD and CVD may be mediated by arterial stiffness. Secretions of inflammatory mediators are increased in patients with COPD, and chronic inflammation is related to CVD and contributes to the development of CVD in patients with COPD [5, 6, 7].
Letter to the editor Corresponding address Ahmet Çağrı Aykan Department of Cardiology Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital Soğuksu Mahallesi, Çamlık Caddesi 61040 Trabzon Turkey [email protected]
Compliance with ethical guidelines Conflict of interest. A.Ç. Aykan states that there are no conflicts of interest.
References 1. Aykan a Ç, Gökdeniz T, Boyacı F et al (2013) Assessment of arterial stiffness in chronic obstructive pulmonary disease by a novel method: cardio-ankle vascular index. Herz. doi:10.1007/s00059-0133902-3 2. Balta I, Balta S, Demirkol S et al (2013) Aortic arterial stiffness is a moderate predictor of cardiovascular disease in patients with psoriasis vulgaris. Angiology 3. Altun B, Bulucu F, Demirbas S et al (2012) The Relationship between some of the cardiovascular risk factors and arterial stiffness parameters in essentially hypertensive patients. Clin Exp Hypertens. (Epub ahead of print) 4. Maclay JD, McAllister DA, Mills NL et al (2009) Vascular dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 180(6):513–520 5. Sin DD, Man SF (2007) Systemic inflammation and mortality in chronic obstructive pulmonary disease. Can J Physiol Pharmacol 85:141–147 6. Agustí A, Faner R (2012) Systemic inflammation and comorbidities in chronic obstructive pulmonary disease. Proc Am Thorac Soc 9(2):43–46 7. Agustí A, Edwards LD, Rennard SI et al (2012) For the evaluation of COPD longitudinally to Identify predictive surrogate endpoints (ECLIPSE) investigators. Persistent systemic inflammation is associated with poor clinical outcomes in COPD: a novel phenotype. Plos One 7(5):e37483