{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T12:16:46Z","timestamp":1780575406350,"version":"3.54.1"},"reference-count":65,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Several cohort studies have demonstrated a link between subclinical carotid atherosclerosis and obstructive chronic airflow limitation. These conditions exhibit common risk factors associated with unhealthy lifestyles, as well as analogous pathophysiological mechanisms, including chronic low-degree systemic inflammation. Purpose: The aim of this study was to investigate the association between airflow obstruction and carotid intima\u2013media thickness (c-IMT), together with the influence of inflammatory biomarkers on this relationship, in patients diagnosed with chronic obstructive pulmonary disease (COPD). Methods and Patients: This study is cross-sectional and includes 106 patients with stable COPD. All patients underwent evaluation through spirometry, carotid ultrasound, and assessment of inflammatory biomarkers, including C-reactive protein, fibrinogen, and erythrocyte sedimentation rate. The relationship between carotid subclinical atherosclerosis and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage of COPD was assessed. Additionally, we compared patients with two positive biomarkers of inflammation with those who had no positive inflammatory biomarkers. Results: Significant statistical differences were observed in carotid intima\u2013media thickness values associated with the severity of airflow obstruction, with measurements of 1.03 mm in COPD stage 1\u20132 GOLD, 1.07 mm in COPD GOLD 3, and 0.96 mm in GOLD 4 (p = 0.04). However, no direct correlation with forced expiratory volume in the first second (FEV1) was identified. The post hoc analysis revealed a notable increase in carotid wall thickness for the early stages of COPD. C-IMT demonstrated a significant association with inflammation parameters, muscle dysfunction, body composition, and lipid profile. The comparison of groups exhibiting two positive inflammatory biomarkers with those with no positive inflammatory markers revealed significant differences in age, c-IMT, exercise tolerance, and COPD symptoms. Conclusions: Subclinical carotid atherosclerosis is evident from the early stages of obstructive airflow limitation. Carotid intima\u2013media thickness is significantly higher in patients with positive inflammatory biomarkers.<\/jats:p>","DOI":"10.3390\/jcm15010180","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T08:38:14Z","timestamp":1766738294000},"page":"180","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Subclinical Carotid Atherosclerosis Is Present from Early COPD Stages, Being in a Close Relationship with Systemic Inflammation"],"prefix":"10.3390","volume":"15","author":[{"given":"Ioana","family":"Ciortea","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Square, RO-300041 Timisoara, Romania"},{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Square, RO-300041 Timisoara, Romania"},{"name":"Department of Biology and Life Sciences, \u201cVasile Goldis\u201d University, 94 Revolutiei Boulevard, RO-310002 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6667-3185","authenticated-orcid":false,"given":"Emanuela","family":"Vastag","sequence":"additional","affiliation":[{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Square, RO-300041 Timisoara, Romania"},{"name":"Pulmonology University Clinic, Clinical Hospital of Infectious Diseases and Pneumophthisiology \u201cDr. Victor Babe\u0219\u201d, 13 Gheorghe Adam Street, RO-300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1714-6830","authenticated-orcid":false,"given":"Cornelu\u021ba","family":"Fira-Mladinescu","sequence":"additional","affiliation":[{"name":"Center for Studies in Preventive Medicine, Hygiene Department, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 16 Victor Babe\u0219 Boulevard, RO-300226 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6020-4593","authenticated-orcid":false,"given":"Alexandru Florian","family":"Crisan","sequence":"additional","affiliation":[{"name":"Research Center for the Assessment of Human Motion, Functionality and Disability (CEMFD), \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Square, RO-300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0749-8232","authenticated-orcid":false,"given":"Norbert","family":"Wellmann","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Square, RO-300041 Timisoara, Romania"},{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Square, RO-300041 Timisoara, Romania"},{"name":"Pulmonology University Clinic, Clinical Hospital of Infectious Diseases and Pneumophthisiology \u201cDr. Victor Babe\u0219\u201d, 13 Gheorghe Adam Street, RO-300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5270-1464","authenticated-orcid":false,"given":"Ana Adriana","family":"Trusculescu","sequence":"additional","affiliation":[{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Square, RO-300041 Timisoara, Romania"},{"name":"Pulmonology University Clinic, Clinical Hospital of Infectious Diseases and Pneumophthisiology \u201cDr. Victor Babe\u0219\u201d, 13 Gheorghe Adam Street, RO-300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9391-0200","authenticated-orcid":false,"given":"Nicoleta Sorina","family":"Bertici","sequence":"additional","affiliation":[{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Square, RO-300041 Timisoara, Romania"},{"name":"Pulmonology University Clinic, Clinical Hospital of Infectious Diseases and Pneumophthisiology \u201cDr. Victor Babe\u0219\u201d, 13 Gheorghe Adam Street, RO-300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Traila","sequence":"additional","affiliation":[{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Square, RO-300041 Timisoara, Romania"},{"name":"Pulmonology University Clinic, Clinical Hospital of Infectious Diseases and Pneumophthisiology \u201cDr. Victor Babe\u0219\u201d, 13 Gheorghe Adam Street, RO-300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Oancea","sequence":"additional","affiliation":[{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Square, RO-300041 Timisoara, Romania"},{"name":"Pulmonology University Clinic, Clinical Hospital of Infectious Diseases and Pneumophthisiology \u201cDr. Victor Babe\u0219\u201d, 13 Gheorghe Adam Street, RO-300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9034-5218","authenticated-orcid":false,"given":"Ovidiu","family":"Fira-Mladinescu","sequence":"additional","affiliation":[{"name":"Center for Research and Innovation in Personalized Medicine of Respiratory Diseases (CRIPMRD), \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 2 Eftimie Murgu Square, RO-300041 Timisoara, Romania"},{"name":"Pulmonology University Clinic, Clinical Hospital of Infectious Diseases and Pneumophthisiology \u201cDr. Victor Babe\u0219\u201d, 13 Gheorghe Adam Street, RO-300310 Timisoara, 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Respir. J."},{"key":"ref_2","unstructured":"(2025, June 30). The Top 10 Causes of Death. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/the-top-10-causes-of-death."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1164\/rccm.201209-1665OC","article-title":"Clusters of Comorbidities Based on Validated Objective Measurements and Systemic Inflammation in Patients with Chronic Obstructive Pulmonary Disease","volume":"187","author":"Vanfleteren","year":"2013","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1183\/09031936.00128008","article-title":"Systemic Manifestations and Comorbidities of COPD","volume":"33","author":"Barnes","year":"2009","journal-title":"Eur. Respir. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1164\/rccm.201402-0373ST","article-title":"An Official American Thoracic Society\/European Respiratory Society Statement: Update on Limb Muscle Dysfunction in Chronic Obstructive Pulmonary Disease","volume":"189","author":"Maltais","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Zhang, L., Jiang, F., Xie, Y., Mo, Y., Zhang, X., and Liu, C. (2023). Diabetic Endothelial Microangiopathy and Pulmonary Dysfunction. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1073878"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"105249","DOI":"10.1016\/j.jbspin.2021.105249","article-title":"The Impact of Osteoporosis and Vertebral Compression Fractures on Mortality and Association with Pulmonary Function in COPD: A Meta-Analysis","volume":"89","author":"Kakoullis","year":"2022","journal-title":"Joint Bone Spine"},{"key":"ref_8","first-page":"1289","article-title":"Overview of the Prevalence, Impact, and Management of Depression and Anxiety in Chronic Obstructive Pulmonary Disease","volume":"9","author":"Panagioti","year":"2014","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_9","unstructured":"(2023, June 03). Hospitalizations and Mortality in the Lung Health Study. Available online: https:\/\/www.atsjournals.org\/doi\/epdf\/10.1164\/rccm.2110093?role=tab."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"107112","DOI":"10.1016\/j.rmed.2022.107112","article-title":"Mortality of Asthma, COPD, and Asthma-COPD Overlap during an 18-Year Follow Up","volume":"207","author":"Mattila","year":"2023","journal-title":"Respir. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1186\/s12931-018-0920-y","article-title":"Association of Lung Function with Cardiovascular Risk: A Cohort Study","volume":"19","author":"Wang","year":"2018","journal-title":"Respir. Res."},{"key":"ref_12","first-page":"341","article-title":"Subclinical Cardiovascular Disease in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review","volume":"110","author":"Ye","year":"2017","journal-title":"QJM Mon. J. Assoc. Physicians"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.5551\/jat.55996","article-title":"Close Association between Subclinical Atherosclerosis and Pulmonary Function in Middle-Aged Male Smokers","volume":"27","author":"Sugiura","year":"2020","journal-title":"J. Atheroscler. Thromb."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/s11883-014-0435-z","article-title":"Inflammation and Cardiovascular Disease: From Pathogenesis to Therapeutic Target","volume":"16","author":"Golia","year":"2014","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1056\/NEJM200003233421202","article-title":"C-Reactive Protein and Other Markers of Inflammation in the Prediction of Cardiovascular Disease in Women","volume":"342","author":"Ridker","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Wedzicha, J.A., Brill, S.E., Allinson, J.P., and Donaldson, G.C. (2013). Mechanisms and Impact of the Frequent Exacerbator Phenotype in Chronic Obstructive Pulmonary Disease. BMC Med., 11.","DOI":"10.1186\/1741-7015-11-181"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Agust\u00ed, A., Edwards, L.D., Rennard, S.I., MacNee, W., Tal-Singer, R., Miller, B.E., Vestbo, J., Lomas, D.A., Calverley, P.M.A., and Wouters, E. (2012). Persistent Systemic Inflammation Is Associated with Poor Clinical Outcomes in COPD: A Novel Phenotype. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0037483"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.1016\/j.rmed.2014.07.013","article-title":"Eclipse Investigators Persistent Systemic Inflammation and Symptoms of Depression among Patients with COPD in the ECLIPSE Cohort","volume":"108","author":"Janssen","year":"2014","journal-title":"Respir. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1152\/japplphysiol.00981.2012","article-title":"Pathophysiology of Muscle Dysfunction in COPD","volume":"114","author":"Gea","year":"2013","journal-title":"J. Appl. Physiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.2147\/COPD.S89814","article-title":"Balance Impairment and Systemic Inflammation in Chronic Obstructive Pulmonary Disease","volume":"10","author":"Tudorache","year":"2015","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1002\/jcsm.12901","article-title":"Pathogenesis of Sarcopenia and the Relationship with Fat Mass: Descriptive Review","volume":"13","author":"Li","year":"2022","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"18","DOI":"10.5551\/jat.31989","article-title":"Carotid Intima-Media Thickness for Atherosclerosis","volume":"23","author":"Nezu","year":"2016","journal-title":"J. Atheroscler. Thromb."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1161\/ATVBAHA.123.320138","article-title":"Assessment of Subclinical Atherosclerosis in Asymptomatic People In Vivo: Measurements Suitable for Biomarker and Mendelian Randomization Studies","volume":"44","author":"Garg","year":"2024","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1002\/clc.22695","article-title":"The Relationship between Cardio-Ankle Vascular Index and Subclinical Atherosclerosis Evaluated by Cardiac Computed Tomographic Angiography","volume":"40","author":"Matsumoto","year":"2017","journal-title":"Clin. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"101","DOI":"10.5551\/jat.13.101","article-title":"A Novel Blood Pressure-Independent Arterial Wall Stiffness Parameter; Cardio-Ankle Vascular Index (CAVI)","volume":"13","author":"Shirai","year":"2006","journal-title":"J. Atheroscler. Thromb."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1291\/hypres.30.767","article-title":"Associations of Brachial-Ankle Pulse Wave Velocity and Carotid Atherosclerotic Lesions with Silent Cerebral Lesions","volume":"30","author":"Matsumoto","year":"2007","journal-title":"Hypertens. Res. Off. J. Jpn. Soc. Hypertens."},{"key":"ref_27","first-page":"601","article-title":"Association between Carotid Intima-Media Thickness and Presence of Coronary Artery Disease in Chronic Obstructive Pulmonary Disease Patients","volume":"16","author":"Koseoglu","year":"2015","journal-title":"Anatol. J. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1016\/j.rmed.2009.10.027","article-title":"Association of COPD with Carotid Wall Intima-Media Thickness in Vascular Surgery Patients","volume":"104","author":"Flu","year":"2010","journal-title":"Respir. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12968-020-0604-x","article-title":"Assessment of Carotid Atherosclerotic Disease Using Three-Dimensional Cardiovascular Magnetic Resonance Vessel Wall Imaging: Comparison with Digital Subtraction Angiography","volume":"22","author":"Wang","year":"2020","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"137","DOI":"10.4103\/0970-2113.152624","article-title":"Subclinical Atherosclerotic Vascular Disease in Chronic Obstructive Pulmonary Disease: Prospective Hospital-Based Case Control Study","volume":"32","author":"Chindhi","year":"2015","journal-title":"Lung India Off. Organ Indian Chest Soc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1111\/j.1752-699X.2008.00089.x","article-title":"Inflammatory Markers in COPD","volume":"2","author":"Larsson","year":"2008","journal-title":"Clin. Respir. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"291","DOI":"10.3109\/07853890.2012.732703","article-title":"Systemic Inflammatory Biomarkers and Co-Morbidities of Chronic Obstructive Pulmonary Disease","volume":"45","author":"MacNee","year":"2013","journal-title":"Ann. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1136\/thx.2003.019588","article-title":"Association between Chronic Obstructive Pulmonary Disease and Systemic Inflammation: A Systematic Review and a Meta-Analysis","volume":"59","author":"Gan","year":"2004","journal-title":"Thorax"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1183\/09031936.00165410","article-title":"Subclinical Atherosclerosis, Airflow Obstruction and Emphysema: The MESA Lung Study","volume":"39","author":"Barr","year":"2012","journal-title":"Eur. Respir. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1164\/rccm.200804-560OC","article-title":"Airflow Limitation in Smokers Is Associated with Subclinical Atherosclerosis","volume":"179","author":"Iwamoto","year":"2009","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.atherosclerosis.2004.12.012","article-title":"Impaired Lung Function and Subclinical Atherosclerosis. The ARIC Study","volume":"180","author":"Schroeder","year":"2005","journal-title":"Atherosclerosis"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Gilbert, R.F., Cichowitz, C., Bibangambah, P., Kim, J.-H., Hemphill, L.C., Yang, I.T., Sentongo, R.N., Kakuhikire, B., Christiani, D.C., and Tsai, A.C. (2022). Lung Function and Atherosclerosis: A Cross-Sectional Study of Multimorbidity in Rural Uganda. BMC Pulm. Med., 22.","DOI":"10.1186\/s12890-021-01792-0"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1164\/rccm.201206-1046OC","article-title":"Chronic Obstructive Pulmonary Disease and Lipid Core Carotid Artery Plaques in the Elderly: The Rotterdam Study","volume":"187","author":"Lahousse","year":"2013","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_39","first-page":"487","article-title":"Pulmonary Function Test and Carotid Intima-Media Thickness in Chronic Obstructive Pulmonary Disease","volume":"16","author":"Sorouri","year":"2025","journal-title":"Casp. J. Intern. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1111\/j.1440-1843.2007.01136.x","article-title":"Cardiovascular Risk in Chronic Obstructive Pulmonary Disease","volume":"12","author":"Maclay","year":"2007","journal-title":"Respirology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e30078","DOI":"10.1097\/MD.0000000000030078","article-title":"Endothelial Dysfunction: The Possible Link between Cardiovascular Comorbidities and Phenomenon of Inflammaging from COPD","volume":"101","author":"Tudorache","year":"2022","journal-title":"Medicine"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e586","DOI":"10.1002\/hsr2.586","article-title":"Association of Chronic Inflammation with Cardiovascular Risk in Chronic Obstructive Pulmonary Disease-A Cross-Sectional Study","volume":"5","author":"Balta","year":"2022","journal-title":"Health Sci. Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1183\/09031936.00133805","article-title":"Mortality in COPD: Role of Comorbidities","volume":"28","author":"Sin","year":"2006","journal-title":"Eur. Respir. J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1136\/thorax-2022-218724","article-title":"Mortality in Non-Exacerbating COPD: A Longitudinal Analysis of UK Primary Care Data","volume":"78","author":"Lenoir","year":"2023","journal-title":"Thorax"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1901217","DOI":"10.1183\/13993003.01217-2019","article-title":"Trajectory and Mortality of Preserved Ratio Impaired Spirometry: The Rotterdam Study","volume":"55","author":"Wijnant","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e195","DOI":"10.1016\/j.atherosclerosis.2007.07.006","article-title":"C-Reactive Protein Is Related to Extent and Progression of Coronary and Extra-Coronary Atherosclerosis; Results from the Rotterdam Study","volume":"195","author":"Kardys","year":"2007","journal-title":"Atherosclerosis"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.1161\/STROKEAHA.106.476135","article-title":"High-Sensitivity C-Reactive Protein Is Not Associated with Carotid Intima-Media Progression: The Carotid Atherosclerosis Progression Study","volume":"38","author":"Lorenz","year":"2007","journal-title":"Stroke"},{"key":"ref_48","first-page":"24","article-title":"Carotid Intima-Media Thickness in Patients with Chronic Obstructive Pulmonary Disease","volume":"112","author":"Pobeha","year":"2011","journal-title":"Bratisl. Lek. Listy"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1038\/sj.ijo.0802515","article-title":"The Relation of Obesity throughout Life to Carotid Intima-Media Thickness in Adulthood: The Bogalusa Heart Study","volume":"28","author":"Freedman","year":"2004","journal-title":"Int. J. Obes. Relat. Metab. Disord. J. Int. Assoc. Study Obes."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"117521","DOI":"10.1016\/j.cca.2023.117521","article-title":"Relationship between the Cholesterol and Triglyceride Content of Lipoprotein Subclasses and Carotid Intima-Media Thickness: A Cross-Sectional Population-Based Study","volume":"548","author":"Ikezaki","year":"2023","journal-title":"Clin. Chim. Acta Int. J. Clin. Chem."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Huang, W., Nie, W., Zhao, J., Fan, Z., Wang, D., Wu, X., Hao, Y., and Wu, S. (2024). The Association of Cumulative Low-Density Lipoprotein Cholesterol Exposure and Carotid Intima-Media Thickness in a Young Adulthood Population. BMC Cardiovasc. Disord., 24.","DOI":"10.1186\/s12872-024-03977-x"},{"key":"ref_52","first-page":"990","article-title":"Lipoprotein Profile in Patients with Chronic Obstructive Pulmonary Disease in a Tertiary Care Hospital in South India","volume":"5","author":"Niranjan","year":"2011","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1111\/j.1749-6632.2000.tb06651.x","article-title":"Inflamm-Aging. An Evolutionary Perspective on Immunosenescence","volume":"908","author":"Franceschi","year":"2000","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s12016-021-08899-6","article-title":"Immunology of Aging: The Birth of Inflammaging","volume":"64","author":"Fulop","year":"2023","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1002\/clc.22934","article-title":"Relation between Age and Carotid Artery Intima-Medial Thickness: A Systematic Review","volume":"41","author":"Jones","year":"2018","journal-title":"Clin. Cardiol."},{"key":"ref_56","first-page":"301","article-title":"Age Should Be Considered in Cut-off Values for Increased Carotid Intima-Media Thickness","volume":"47","year":"2019","journal-title":"Turk Kardiyol. Dern. Ars. Turk Kardiyol. Derneginin Yayin. Organidir"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/s41533-022-00292-w","article-title":"Annual Decline Rate in FEV1s in Community-Dwelling Older Adults Diagnosed with Mild to Moderate COPD","volume":"32","author":"Rosso","year":"2022","journal-title":"npj Prim. Care Respir. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1007\/s11883-015-0510-0","article-title":"Potential Contributions of Intimal and Plaque Hypoxia to Atherosclerosis","volume":"17","author":"Fong","year":"2015","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_59","first-page":"848","article-title":"Hypoxia-Induced Changes in Endothelial Cell Phenotype and Function","volume":"43","author":"Jeney","year":"2025","journal-title":"Antioxid. Redox Signal."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e038360","DOI":"10.1136\/bmjopen-2020-038360","article-title":"Cardiovascular Risk Prediction Using Physical Performance Measures in COPD: Results from a Multicentre Observational Study","volume":"10","author":"Fermont","year":"2020","journal-title":"BMJ Open"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1111\/crj.13006","article-title":"Higher Serum Levels of Systemic Inflammatory Markers Are Linked to Greater Inspiratory Muscle Dysfunction in COPD","volume":"13","author":"Formiga","year":"2019","journal-title":"Clin. Respir. J."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e171","DOI":"10.1016\/j.amjmed.2020.07.004","article-title":"Systemic Inflammation, Vascular Function, and Endothelial Progenitor Cells after an Exercise Training Intervention in COPD","volume":"134","author":"Patti","year":"2021","journal-title":"Am. J. Med."},{"key":"ref_63","unstructured":"(2025, September 21). Tobacco Control: Monitor: Current Tobacco Use, Tobacco Smoking and Cigarette Smoking, Estimate, Non-Age-Standardized. Available online: https:\/\/www.who.int\/data\/gho\/data\/indicators\/indicator-details\/GHO\/gho-tobacco-control-monitor-current-tobaccouse-tobaccosmoking-cigarrettesmoking-nonagestd-tobnonagestdcurr."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"3406","DOI":"10.4103\/jfmpc.jfmpc_1878_24","article-title":"Diagnosed and Underdiagnosed Cases of COPD in the Primary Care Setting: Differences and Similarities","volume":"14","author":"Filippou","year":"2025","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1080\/17476348.2021.1840982","article-title":"Advances in Understanding of Mechanisms Related to Increased Cardiovascular Risk in COPD","volume":"15","author":"Rogliani","year":"2021","journal-title":"Expert Rev. Respir. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/180\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T08:48:57Z","timestamp":1766738937000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/180"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,26]]},"references-count":65,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15010180"],"URL":"https:\/\/doi.org\/10.3390\/jcm15010180","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,26]]}}}