Increased high density lipoprotein cholesterol in obstructive pulmonary disease (predominant emphysematous type)

Since increased levels of high density lipoprotein-cholesterol (HDL-C) seem to be protective against coronary heart disease, there is increasing interest in mechanisms whereby HDL-C levels can be increased. Recent studies suggest that exercise can elevate HDL-C. Patients with chronic obstructive pulmonary disease (COPD), who are usually considered as leading sedentary lifestyles, have an increased work of breathing and their respiratory muscles may be considered to be under a chronic exercise load. Twenty-nine male patients with COPD were selected on the basis of their clinicalphysiologic data, which suggested a predominant emphysematous component of their disease. Clinical features and pulmonary function studies characterized the patients as having relatively pure emphysema (i.e., pink puffers): weight 98% ± 4% (SE) of ideal body weight; absence of cough and sputum; no evidence of cor pulmonale; overinflation in each patient by chest roentgenogram and either curvilinear lines or bullae in 25 of 29 patients; arterial oxygen tension, 62.7 ± 1.4 mm Hg; arterial carbon dioxide tension, 39.8 ± 1.3 mm Hg; severely reduced expiratory flow rate for the midportion of the forced expiratory curve, 0.27 ± 0.02 LPS; overinflation with a residual volume to total lung capacity ratio of 67% ± 1.5% (normal <35%); marked loss of elastic recoil with a transpulmonary pressure at total lung capacity of 14.9 ± 1.82 cm H20 (normal > 19) and a coefficient of retraction of 1.9 ± 0.27 cm H20/liter (normal range 2.5-8.5); minute ventilation (VE) of 10.8 ± .24 liters (normal 6.37 ± 0.9); oxygen consumption (Vo₂) of 251 ± 9 ml (normal 230 ± 30); ventilatory equivalent (V E/Vo₂), 44 ± 1.9 (normal 20-30). Levels of HDL-C were 72 ± 4 mg/dl vs. 54 ± 3 mg/dl for controls matched for age, obesity index, alcoholic intake, smoking history, and race. The HDL-C levels in the patient group were similar to those reported by other workers for long distance runners, and cross country skiers. We suggest these data provide another link between increased levels of HDL-C and exercise.