Arterial Stiffness in Pre-COPD/PRISm, and COPD Stages: A Cross-Sectional Assessment of Hemodynamic Determinants

Purpose: Arterial stiffness is associated with increased cardiovascular risk in chronic obstructive pulmonary disease (COPD). However, whether this increase reflects disease-specific vascular effects or is primarily driven by age and hemodynamic factors remains unclear, particularly in early disease states such as pre-COPD and preserved ratio impaired spirometry (PRISm). This study aimed to evaluate arterial stiffness across the COPD spectrum and to determine the independent predictors of pulse wave velocity (PWV). Patients and Methods: This cross-sectional study included healthy controls (n=60), a combined pre-COPD/PRISm group (n=121), and COPD patients (n=120) classified according to spirometric criteria. Arterial stiffness was assessed noninvasively using brachial oscillometric PWV. Clinical characteristics, smoking exposure, spirometric parameters, symptom scores, and hemodynamic measurements were recorded. Correlation analyses and hierarchical multivariate linear regression were performed to identify independent determinants of PWV. Results: PWV values were significantly higher in the pre-COPD/PRISm and COPD groups than in healthy controls, with the highest levels observed in COPD patients at GOLD stage E (p< 0.001). Although PWV showed significant correlations with spirometric parameters and symptom scores in unadjusted analyses, these associations lost significance after adjustment for age and smoking exposure. In contrast, mean arterial pressure and central pulse pressure remained strongly associated with PWV (p< 0.001). In multivariate analysis, age was the strongest independent predictor of PWV, followed by mean arterial pressure and body surface area, while FEV1% was not a significant contributor. Conclusion: Arterial stiffness is increased not only in COPD but also in individuals with pre-COPD/PRISm. However, this increase appears to be primarily driven by age-related and hemodynamic factors rather than disease-specific airflow limitation. These findings highlight the importance of early cardiovascular risk assessment focusing on hemodynamic parameters. Keywords: COPD, Pre-COPD, PRISm, arterial stiffness, pulse wave velocity, hemodynamic determinants