Metabolic Syndrome in Chemical Warfare Patients with Chronic Obstructive Pulmonary Disease

Document Type : Original Article

Authors

1 Pulmonologist , Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Pulmonologist,COPD Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Endocrinologist,Endocrinology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Internist,COPD Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

5 Internist,COPD Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

6 Specialist in Community Medicine,School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

7 Pathologist, Cancer Molecular Pathology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

8 Clinical Nutrician, Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

 
Introduction: Sulfur mustard (SM), a toxic alkylating gas, can cause serious long-term pulmonary complications such as chronic obstructive pulmonary disease (COPD). Metabolic syndrome (MetS) is one of the important comorbidities of COPD. This study was designed to evaluate the frequency of metabolic syndrome in Iranian chemical warfare patients (CWPs) with COPD.
Materials and Methods: Thirty CWPs with a mean age of 46.93± 6.8 were enrolled in this study. The following parameters were studied in: complete pulmonary function tests, health-related quality of life, serum triglycerides (TG), high density lipoprotein (HDL) and fasting blood sugar (FBS) levels. Additionally, 32 COPD patients and 56 healthy persons were considered as control groups who were matched to CWPs.
Results: We found a statistically significant difference in the frequency of MetS between the COPD patients and the healthy control group (p=0.04). Additionally, we observed a statistically significant difference in the mean HDL levels among these groups (p=<0.001). In the CWPs, the frequency of MetS was significantly decreased in severe to very severe stages (p<0.001).
Conclusion: Our data indicate that metabolic syndrome is frequent in chemical warfare patients, and special attention to this condition in mild to moderate stages is recommended.

Keywords


1. Balali-Mood M, Hefazi M. Comparison of early and late toxic effects of sulfur mustard in Iranian veterans. Basic ClinPharmacolToxicol 2006; 99: 273–282.
2. Ghanei M, Adibi I. Clinical review of mustard lung.IJMS 2007; 32: 58–65.
3. Attaran D, Lari SM, Khajehdaluee M, Ayatollahi H, Towhidi M, Marallu HG, et al. Highly sensitive C-reactive protein levels in Iranian patients with pulmonary complication of sulfur mustard poisoning and its correlation with severity of airway diseases. Hum ExpToxicol 2009; 28(12):739-745.
4. Attaran D, Lari SM, Towhidi M, Marallu HG, Ayatollahi H, Khajehdaluee M, et al. Interleukin-6 and airflow limitation in chemical warfare patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2010 ; 5 : 335-340.
5. Ghanei M, Amiri S, Akbari H, Kosari F, Khalili A, Alaeddini F, et al. Correlation of sulfur mustard exposure and tobacco use with expression (immunoreactivity) of p53 protein in bronchial epithelium of Iranian “mustard lung” patients. Mil Med 2007;172:70–74.
6. Balali-Mood M, Hefazi M, Mahmoudi M, Jalali E, Attaran D, Maleki M, et al. Long-term complications of sulfur mustard poisoning in severely intoxicated Iranian veterans. FundamClinPharmacol 2005;19:713–721.
7. Khateri S, Ghanei M, Keshavarz S, Soroush M, Hainez D. Incidence of lung, eye, and skin lesions as late complications in 34,000 Iranians with wartime exposure to mustard agent. J Occup Environ Med 2003;45:1136–1143. 
8. Fabbri LM, Rabe KF. From COPD to chronic systemic inflammatory syndrome?Lancet 2007 ;370:797-9.
9. Watz H, Waschki B, Kirsten A, Müller KC, Kretschmar G, Meyer T, et al. The metabolic syndrome in patients with chronic bronchitis and COPD: frequency and associated consequences for systemic inflammation and physical inactivity. Chest 2009;136:1039-46.
10. Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM, et al. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet 2007; 370: 741-750.
11.Mannino DM, Watt G, Hole D, Gillis C, Hart C, McConnachie A, et al. The natural history of chronic obstructive pulmonary disease.EurRespir J 2006; 27: 627-643.
12. Fabbri LM, Rabe KF. Multiple chronic diseases.In: Proceedings of a European Respiratoey Society Research Seminar. Rome, Italy; Feb 11-12, 2007. Available at: http:// www.ersnet.org/ers/browse/default.aspx?id=31439.
13. Groenewegen KH, Postma DS, Hop WC, Wielders PL, Schlösser NJ, Wouters EF, et al. Increased systemic inflammation is a risk factor for COPD exacerbations. Chest 2008 ; 133: 350-357.
14. Watz H, Waschki B, Boehme C, Claussen M, Meyer T, Magnussen H. Extrapulmonary effects of chronic obstructive pulmonary disease on physical activity: a cross-sectional study, Am J RespirCrit Care Med 2008 ;177: 743-751. 
 15. Ford ES, Giles WH, Dietz WH; Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey JAMA 2002; 287: 356-359.
16. Sahebari M, Goshayeshi L, Mirfeizi Z, Rezaieyazdi Z, Hatef MR, Ghayour-Mobarhan M, et al. Investigation of the association between metabolic syndrome and disease activity in rheumatoid arthritis. ScientificWorld Journal 2011; 11:1195-205.
17. Nezhad MA, Ghayour-Mobarhan M, Parizadeh SM, Safarian M, Esmaeili H, Khodaei GH, et al. Metabolic syndrome: its prevalence and relationship to socio-economic parameters in an Iranian population. Nutr.Metab.Cardiovasc. Dis. 2008; 18: e11–12.
18. Pauwels RA, Buist AS, Caleverley PM, Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global initiative for Obstructive Lung Disease (GOLD) workshop summary. Am J RespirCrit Care Med 2001;163:1256–1276.
19. American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J RespirCrit Care Med 1995;52:S77–S121.
20. Ebrahimi M, Kazemi-Bajestani SM, Ghayour-Mobarhan M, Moohebati M, Paydar R, Azimi-Nezhad M, et al. Metabolic syndrome may not be a good predictor of coronary artery disease in the Iranian population: population-specific definitions are required. Scientific World Journal 2009;9:86-96.
 21. Marquis K, Maltais F, Duguay V, Bezeau AM, LeBlanc P, Jobin J, et al. The metabolic syndrome in patients with chronic obstructive pulmonary disease. J CardiopulmRehabil 2005; 25: 226-32.
22. Grundy SM, Brewer Jr HB, Cleeman JI, Smith Jr SC, Lenfant C. Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004;109:433e8.
23. Celli BR, Cote CG, Marin JM, Casanova C, Mondez RA, Pinto-Plata V, et al. The body mass index, airflow obstruction, dyspnea and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004;350:1005–1012.
24. American Thoracic Society. ATS statement: Guidelines for the six-minute walk test. Am J RespirCrit Care Med 2002; 166: 111–129.
25. Halvani A, Pourfarokh P, Nasiriani K. Quality of life and related factors in patients with chronic obstructive pulmonary disease. Tanaffos 2006;5: 51–56.
26. Agusti A. Systemic effects of chronic obstructive pulmonary disease: what we know and what we don’t know (but should). Proc Am ThoracSoc 2007; 4: 522-525.
27. Wouters EF. Local and systemic inflammation in chronic obstructive pulmonary disease.Proc Am ThoracSoc 2005; 2: 26-33.
28. Yanbaeva DG, Dentener MA, Creutzberg EC, Wesseling G, Wouters EF. Systemic effects of smoking. Chest 2007; 131: 1557-1566.
 29. Pourfarzam S, Ghazanfari T, Yaraee R, Ghasemi H, Hassan ZM, Faghihzadeh S, et al. Serum levels of IL-8 and IL-6 in the long term pulmonary complications induced by sulfur mustard: Sardasht-Iran Cohort Study. IntImmunopharmacol 2009;9:1482–1488.
30. Rogliani P, Curradi G, Mura M, Lauro D, Federici M, Galli A, et al. Metabolic syndrome and risk of pulmonary involvement. Respir Med 2010; 104:47-51.
31. Tisi GM, Conrique A, Barrett-Connor E, Grundy SM. Increased high density lipoprotein cholesterol in obstructive pulmonary disease (predominant emphysematous type). Metabolism 1981;30:340-346.
32. Bolton CH, Mulloy E, Harvey J, Downs LG, Hartog M. Plasma and lipoprotein lipids and apolipoproteins AI, AII, and B in patients with chronic airflow limitation. J R Soc Med 1989;82:91-92.