Comparison of cerebral blood flow in subjects with and without chronic obstructive pulmonary disease from the population-based Rotterdam Study

Objectives Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cerebrovascular disease, which might be associated with decreases in cerebral blood flow. Since studies examining cerebral blood flow in COPD remain scarce and are limited by sample size, we aimed to study cerebral blood flow in participants with and without COPD. Design Observational cohort study. Setting Population-based Rotterdam Study. Participants 4177 participants (age 68.0 +/- 8.5 years; 53% females) with and without COPD. Predictor variable Spirometry and pulmonary diffusing capacity. Outcome measures Cerebral blood flow by two-dimensional phase-contrast cerebral MRI. Results Compared with subjects with normal spirometry (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) >= 0.7 and FEV1 >= 80%), multivariable adjusted cerebral blood flow (mL/min) was preserved in subjects with COPD Global initiative for Chronic Obstructive Lung Disease (GOLD1) (FEV1/FVC <0.7 and FEV1 >= 80%), but significantly lower in subjects with COPD GOLD2-3 (FEV1/FVC <0.7 and FEV1 <80%), even after adjustment for cardiovascular comorbidities. In sex-stratified analyses, this difference in cerebral blood flow was statistically significant in women but not in men. Cerebral blood flow was lowest in subjects with FEV1, FVC and diffusion lung capacity for carbon monoxide % predicted values in the lowest quintile, even after adjustment for cardiovascular comorbidities and cardiac function. Conclusion We observed a lowered cerebral blood flow in subjects with COPD GOLD2-3.

Automated summary

Cerebral blood flow was found to be reduced in patients with COPD GOLD2-3, especially in those with a FEV1/FVC ratio <0.7 and FEV1 <80%. This difference was more significant in women than in men.