Original clinical scienceAdvanced chronic obstructive pulmonary disease is associated with high levels of high-density lipoprotein cholesterol
Section snippets
Methods
The methods of this study were reviewed and approved by The Johns Hopkins Hospital investigational review board. A total of 289 consecutive COPD patients evaluated at our center for consideration of lung transplantation from 1995 to 2009 were screened for inclusion in the analysis. Fasting lipid profiles were available in 126 of these patients. Patients were sequentially enrolled in a pre-transplant evaluation protocol. The following data were recorded: demographics, anthropometrics, pulmonary
Statistical analysis
Continuous data are expressed as mean ± SD, and categoric data are presented as counts and percentages. Univariate analyses to assess associations with HDL-C included the t test for comparing dichotomous variables, and the Pearson correlation was used to assess the relationship between continuous variables. Assumptions were checked graphically. Comparisons across tertiles of HDL-C were made with analysis of variance, chi-square, and Fisher exact tests, as appropriate. To assess independence of
Results
Clinical characteristics of the 126 study participants are described in Table 1. Patients were primarily white with severe COPD reflected by a mean FEV1 % predicted of 22% ± 10%, and 91% used supplemental oxygen. Left heart catheterization data were available in 88 (70%), and 61% had CAD-A. Despite HDL-C levels >70 mg/dl, 6 patients (5 women) had severe angiographic stenosis of >50% stenosis in the left main coronary or >70% stenosis in another epicardial artery. Two patients with this degree
Discussion
HDL-C levels were elevated in our cohort with severe COPD compared with a reference population without severe COPD or known CAD. Similar trends in HDL-C have been reported in smaller samples of COPD patients.14, 15, 16 Tisi et al15 described 29 men with COPD in whom HDL-C levels were compared with controls matched for age, obesity index, alcohol intake, smoking history, and race. Mean HDL-C values were elevated in the COPD patients at 72 ± 4 vs 54 ± 3 mg/dl for controls.15 Although they found
Study limitations
Although the prospective evaluation of patients through a transplant evaluation protocol strengthens the study and reduces bias, the cohort is still highly selected, with underrepresentation of active tobacco abuse, alcohol abuse, mild to moderate COPD, and heart failure. Only 6 patients carried the diagnosis of heart failure, and there were none with a left ventricular ejection fraction <35%. An association of heart failure with reduced levels of HDL-C has been observed,21 but we found no
Clinical implications
Most smokers do not develop COPD,22 suggesting that a combination of exposure and susceptibility is required. HDL has been shown to exert various anti-inflammatory effects in the lung,9 including binding α-1 anti-trypsin and manifesting its anti-elastase activity.23 HDL also appears to play an important role in COPD by effects on the production, trafficking, and function of surfactant,10, 11 which in turn reciprocally affects HDL24 in a fashion resembling an endocrine system. In a cohort of
Disclosure statement
None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.
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Lipid profile and atherogenic indices in patients with stable chronic obstructive pulmonary disease
2021, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :Most of the existing studies have demonstrated significantly lower values or insignificant difference of HDL-C in COPD patients compared to healthy subjects [16,29,30]. Still, our results are in accordance with Reed et al. who investigated lipid parameters in individuals evaluated for lung transplantation with diagnosis of severe COPD and found significantly higher values of HDL-C compared to healthy subjects [31]; those values were reduced to reference values after lung transplantation [32]. Some other studies also demonstrated elevated HDL-C concentration in COPD patients; however, they recruited a very small number of patients [33,34].
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2019, Pharmacological ReportsCitation Excerpt :In recent years, dyslipidemia has been recognised as a co-morbidity of COPD and a contributor to disease pathogenesis in COPD [1]. Elevated levels of cholesterol [2,3], or oxidized derivatives, such as the oxysterol 25-hydroxycholesterol [4], have been linked to inflammation and other pathologies in COPD. Statins are the conventional treatment for hypercholesterolemia and have also been the subject of extensive research to exploit the potential pleiotropic beneficial effects in COPD, reduction of inflammation in particular, beyond their lipid-lowering impact (reviewed in [5,6]).
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2016, Journal of the American Medical Directors AssociationCitation Excerpt :Only 10% of our patients had low HDL cholesterol at baseline. Elevated HDL-cholesterol levels in advanced COPD patients have been reported previously and have been partly attributed to steroid use.35 Indeed, a recent study revealed a mechanistic relationship between steroids use and elevated HDL-cholesterol.36