***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Chronic obstructive pulmonary disease ( COPD ) is characterized by low pulmonary function , inflammation , free radical production , vascular dysfunction , and subsequently a greater incidence of cardiovascular disease . By administering an acute oral antioxidant cocktail to patients with COPD ( n=30 ) and controls ( n=30 ) , we sought to determine the role of redox balance in the vascular dysfunction of these patients . Using a double-blind , r and omized , placebo-controlled , crossover design , patients with COPD and controls were ingested placebo or the antioxidant cocktail ( vitamin C , vitamin E , & agr;-lipoic acid ) after which brachial artery flow-mediated dilation and carotid-radial pulse wave velocity were assessed using ultrasound Doppler . The patients exhibited lower baseline antioxidant levels ( vitamin C and superoxide dismutase activity ) and higher levels of oxidative stress ( thiobarbituic acid reactive species ) in comparison with controls . The patients also displayed lower basal flow-mediated dilation ( P<0.05 ) , which was significantly improved with antioxidant cocktail ( 3.1±0.5 versus 4.7±0.6 % ; P<0.05 ; placebo versus antioxidant cocktail ) , but not controls ( 6.7±0.6 versus 6.9±0.7 % ; P>0.05 ; placebo versus antioxidant cocktail ) . The antioxidant cocktail also improved pulse wave velocity in patients with COPD ( 14±1 versus 11±1 m·s−1 ; P<0.05 ; placebo versus antioxidant cocktail ) while not affecting controls ( 11±2 versus 10±1 m·s−1 ; P>0.05 ; placebo versus antioxidant ) . Patients with COPD exhibit vascular dysfunction , likely mediated by an altered redox balance , which can be acutely mitigated by an oral antioxidant . Therefore , free radically mediated vascular dysfunction may be an important mechanism contributing to this population ’s greater risk and incidence of cardiovascular disease Background Because chronic obstructive pulmonary disease ( COPD ) is a heterogeneous condition , the identification of specific clinical phenotypes is key to developing more effective therapies . To explore if the persistence of systemic inflammation is associated with poor clinical outcomes in COPD we assessed patients recruited to the well-characterized ECLIPSE cohort ( NCT00292552 ) . Methods and Findings Six inflammatory biomarkers in peripheral blood ( white blood cells ( WBC ) count and CRP , IL-6 , IL-8 , fibrinogen and TNF-α levels ) were quantified in 1,755 COPD patients , 297 smokers with normal spirometry and 202 non-smoker controls that were followed-up for three years . We found that , at baseline , 30 % of COPD patients did not show evidence of systemic inflammation whereas 16 % had persistent systemic inflammation . Even though pulmonary abnormalities were similar in these two groups , persistently inflamed patients during follow-up had significantly increased all-cause mortality ( 13 % vs. 2 % , p<0.001 ) and exacerbation frequency ( 1.5 ( 1.5 ) vs. 0.9 ( 1.1 ) per year , p<0.001 ) compared to non-inflamed ones . As a descriptive study our results show associations but do not prove causality . Besides this , the inflammatory response is complex and we studied only a limited panel of biomarkers , albeit they are those investigated by the majority of previous studies and are often and easily measured in clinical practice . Conclusions Overall , these results identify a novel systemic inflammatory COPD phenotype that may be the target of specific research and treatment STUDY OBJECTIVES Results from several studies have described a relationship between pulmonary function and both all-cause and cause-specific mortality . The purpose of this study was to investigate the predictive value of pulmonary function by gender after 29 years of follow-up . DESIGN Prospect i ve study with 29-year follow-up of the Buffalo Health Study cohort . PARTICIPANTS R and omly selected sample of 554 men and 641 women , aged 20 to 89 years , from all listed households of the city of Buffalo , NY . MEASUREMENTS AND RESULTS Baseline measurements were performed in 1960 to 1961 . Pulmonary function was assessed based on FEV(1 ) expressed as the normal percent predicted ( FEV(1)%pred ) . FEV(1)%pred adjusted by age , body mass index , systolic BP , education , and smoking status was inversely related to all-cause mortality in both men and women ( p<0.01 ) . A sequential survival analysis in participants who had a survival time of at least 5 , 10 , 15 , 20 , and 25 years after enrollment in the study was also performed . Except for men who survived for > 25 years , we observed a statistically significant negative association between FEV(1)%pred and all-cause mortality . FEV(1)%pred was also inversely related to ischemic heart disease ( IHD ) mortality . When participants were divided into quintiles of FEV(1)%pred , participants in the lowest quintile of FEV(1)%pred experienced significantly higher all-cause mortality compared with participants in the highest quintile of FEV(1)%pred . For the entire follow-up period , the adjusted hazard ratios for all-cause mortality were 2.24 ( 95 % confidence interval [ CI ] , 1.60 to 3.13 ) for men and 1 . 81 ( 95 % CI , 1.24 to 2.63 ) for women , respectively . Hazard ratios for death from IHD in the lowest quintile of FEV(1)%pred were 2.11 ( 95 % CI , 1.20 to 3.71 ) and 1.96 ( 95 % CI , 0.99 to 3.88 ) for men and women , respectively . CONCLUSIONS These results suggest that pulmonary function is a long-term predictor for overall survival rates in both genders and could be used as a tool in general health assessment BACKGROUND C-reactive protein ( CRP ) is a sensitive marker of inflammation , and elevated levels have been associated with future risk of myocardial infa rct ion ( MI ) . However , whether measurement of CRP adds to the predictive value of total cholesterol ( TC ) and HDL cholesterol ( HDL-C ) in determining risk is uncertain . METHODS AND RESULTS Among 14916 apparently healthy men participating in the Physicians ' Health Study , baseline levels of  CRP , TC , and HDL-C  were measured among 245 study subjects who subsequently developed a first MI ( cases ) and among 372 subjects who remained free of cardiovascular disease during an average follow-up period of 9 years ( controls ) . In univariate analyses , high baseline levels of CRP , TC , and TC : HDL-C ratio were each associated with significantly increased risks of future MI ( all P values < 0.001 ) . In multivariate analyses , models incorporating CRP and lipid parameters provided a significantly better method to predict risk than did models using lipids alone ( all likelihood ratio test P values < 0.003 ) . For example , relative risks of future MI among those with high levels of both CRP and TC ( RR=5.0 , P=0.0001 ) were greater than the product of the individual risks associated with isolated elevations of either CRP ( RR=1.5 ) or TC ( RR=2.3 ) . In stratified analyses , baseline CRP level was predictive of risk for those with low as well as high levels of TC and the TC : HDL-C ratio . These findings were virtually identical in analyses limited to nonsmokers and after control for other cardiovascular risk factors . CONCLUSIONS In prospect i ve data from a large cohort of apparently healthy men , baseline CRP level added to the predictive value of lipid parameters in determining risk of first MI BACKGROUND : Patients with COPD face an increased risk of cardiovascular disease and increased cardiac mortality . Carotid femoral pulse wave velocity ( cf-PWV ) is a vali date d measure of arterial stiffness , a well recognized predictor of adverse cardiovascular outcomes , and offers higher predictive value than classical cardiovascular risk factors . We investigated the association between COPD and arterial stiffness using cf-PWV as a noninvasive technique . METHODS : This clinical study was prospect i ve , observational , and cross-sectional . Sixty-two subjects with stable COPD and 22 healthy controls underwent physical examination , chest x-rays , pulmonary function tests , arterial blood gas analysis , and 6-min walk test , and cf-PWV was measured via a vali date d tonometry system . RESULTS : The COPD subjects had greater arterial stiffness than the control subjects , and that difference was associated with lower FEV1 , PaO2 , and oxygen saturation during the 6-min walk test . We observed higher cf-PWV in the COPD subjects with severe COPD than in the subjects with mild to moderate COPD . Only FEV1 was an independent predictor of cf-PWV . CONCLUSIONS : Our results suggest that arterial stiffness is increased in subjects with more severe and advanced COPD than in those with mild to moderate COPD . Air flow limitation and hypoxemia may induce increased arterial stiffness in COPD patients Background Cardiovascular morbidity and mortality is high in patients with chronic obstructive pulmonary disease ( COPD ) and arterial stiffness is a potentially modifiable risk factor with added predictive value beyond that obtained from traditional risk factors . Arterial stiffness has been the target of pharmacologic and exercise interventions in patients with COPD , but the effects appear limited to those patients with more significant elevations in arterial stiffness . We aim ed to identify predictors of increased arterial stiffness in a cohort with moderate to severe COPD . Methods  Aortic pulse wave velocity ( aPWV )  was measured in subjects with moderate to severe COPD enrolled in a multicenter r and omized controlled trial . Subjects were categorized into quartiles based on aPWV values and factors affecting high  arterial stiffness  were assessed . Multivariate models were created to identify independent predictors of high aPWV , and cardiovascular disease ( CVD ) . Results 153 patients were included . Mean age was 63.2 ( SD 8.2 ) years and mean FEV1 was 55.4 ( SD 15.2 ) % predicted . Compared to the quartile with the lowest aPWV , subjects in the highest quartile were older , had higher systolic blood pressure ( SBP ) , were more likely to be current smokers , and had greater burden of thoracic aortic calcification . On multivariate analyses , age ( adjusted OR 1.14 , 95%CI 1.05 to 1.25 , p = 0.003 ) and SBP ( adjusted OR 1.06 , 95 % CI 1.02 to 1.09 , p = 0.001 ) were independent predictors of elevated aPWV . Body mass index , therapy with cholesterol lowering medications and coronary calcification were independent predictors of CVD . Conclusions Elevated arterial stiffness in patients with COPD can be predicted using age , blood pressure and thoracic aortic calcification . This will help identify subjects for enrollment in clinical trials using aPWV for assessing the impact of COPD therapies on CV outcomes .Trial registration Clinical trials.gov Introduction : Chronic obstructive pulmonary disease ( COPD ) is an important non-communicable disease worldwide with a rising global incidence . COPD is associated with multiple co-morbidities . Patients with COPD are at increased risk of atherosclerosis and other cardiovascular events . Cardiovascular diseases are an important cause of morbidity and mortality in COPD . The present case-control study was design ed to assess the relationship between sub- clinical atherosclerotic vascular diseases with COPD . Methods : It was a prospect i ve case-control blinded observational study . There were 142 COPD patients and 124 age- and sex-matched controls without COPD and cardiovascular diseases .  Frequency of sub- clinical atherosclerosis was assessed by the carotid B-mode duplex ultrasonography assessment of carotid wall intima medial thickness ( IMT ) . Plaque was defined as IMT of more than 1.2 mm . Results : Prevalence of carotid plaqing was significantly higher amongst patients of COPD ( 38.7 % ) compared to controls ( 13.7 % , odds ratio 3.9 , P < 0.0001 ) . Multinomial logistic regression analysis revealed COPD as an independent predictor of carotid plaqing ( r = 0.85 , P < 0.023 ) . Conclusion : The frequency of carotid plaqing is high in COPD patients . Carotid plaqing may be due to shared risk factors or the presence of low- grade systemic inflammation . Presence of increased CIMT and carotid plaqing in COPD patients identifies early atherosclerotic changes and future cardiovascular risk . Hence screening of CIMT should be a part of cardiovascular assessment in patients with COP 
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Conclusion Although our findings need further evaluation in prospect i ve studies , our review presents significant evidence in support of increased sub clinical CVD burden in COPD patients independent of smoking status .