http://www.americanscience.org ) 4 2012;8( Journal of American Science, 422 Subclinical Atherosclerosis in COPD Smokers: An Egyptian Randomized Controlled study Mohamed Husein 1 ;Tawfik El-Adl 2 ;Reda Baiyumy 3 ;Mohamed Abdulshafy 3 ;Hisham Farouk 4 and Mostafa Neamatallh 5 Chest Diseases 1 ,Internal Medicine 2 ,Cardiology 3 and Radiology 4 Departments,Benha School of Medicine,Benha University,Benha;Medical Biochemistry Department 5 , Mansoura School of Medicine,Mansoura University,Mansoura;Egypt. tawfik61@yahoo.com . Abstract: Background: Chronic Obstructive Pulmonary disease (COPD) is associated with increased morbidity and mortality from cardiovascular disease. Although a close association between COPD and atherosclerosis has been speculated, such scientific information is limited. Aim: The present study aimed to evaluate subclinical atherosclerosis in smokers with COPD. Subjects and Methods: This prospective randomized controlled study was carried out on 90 consecutive Egyptians; at Chest and Internal Medicine Departments of Benha University Hospitals, Benha, Egypt. All patients were consented. Study population was randomized into three groups, each comprized 30 patients. Group one included 30 smokers with COPD. Group two included 30 healthy smokers without lung function abnormalities and Group three included 30 healthy volunteers who never smoked before and with normal lung functions(control group). Subjects with diabetes, hyperlipidemia, acute infections, IHD, and respiratory diseases other than COPD were excluded beforehand. Complete medical history, full clinical and radiological examination, complete blood picture, liver function tests, renal function tests, fasting blood sugar, lipid profile, body mass index(BMI), C-reactive protein, ventilatory pulmonary function tests and carotid ultrasonography were done to all subjects enrolled in the study. We determined Carotid intima- media thickness(IMT) and focal atheromatous plaques as an indicator of subclinical atherosclerosis. Results: Our findings demonstrated that mean carotid intima-media thickness was greater in smokers with COPD than normal smokers group and control never smoke group.Also, focal carotid plaques were significantly more prevalent in COPD smokers group than normal smokers and control never smoke groups. Multivariate analysis showed significant association between thickened carotid intima media and decreased percent of predicted FEV 1 (P=0.001) and between plaques and Log C- reactive protein levels (P=0.013) independent of patient's age, number of smoked packs/ year, body mass index, peripheral mean arterial blood pressure, heart rate, blood glucose, and low density lipoprotein levels. In conclusion, our observations revealed that, COPD smokers had exaggerated subclinical atherosclerosis. This study suggests that middle aged men who are susceptible to COPD may also, be susceptible to vascular atherosclerosis by smoking, and atherosclerosis changes starts early in the disease process of COPD. Recommendations: We recommend more research studies on larger scale at different ages and in both sexes to understand the mechanism of atherosclerosis in COPD smokers and to identify an optimal treatment. [Mohamed Husein;Tawfik El Adl;Reda Baiyumy; Mohamed Abdulshafy; Hisham Farouk; Mostafa Neamatallh. Subclinical Atherosclerosis in COPD Smokers: An Egyptian Randomized Controlled study. J Am Sci 58 . http://www.jofamericanscience.org 1003). - ]. (ISSN: 1545 429 - 422 ): 12 2012;8( Key words: Smoking, atherosclerosis, COPD, carotid 1. Introduction Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality worldwide (1) .Recently, COPD has been recognized as a systemic disease (2) .Of particular interest is the association between COPD and cardiovascular disease (3) . One of the leading causes of death in COPD is cardiovascular disease, which account for approximately 25% to 50% of mortality (4) . COPD is characterized by chronic air flow limitation from an inappropriate and excessive inflammatory response of the lungs to respiratory pollutants, mainly tobacco smoking (5) . Smoking is an established risk factor for cardiovascular diseases, but the effects of smoking seems to be insufficient to explain excessive cardio vascular risk in COPD (6) . Recent advances suggest that the mechanism linking increased cardiovascular disease and COPD is potentially explained by persistent low grade systemic inflammation as indicated by elevated levels of C-reactive protein (CRP) observed in patients with COPD (7) . The levels of CRP are associated with cardiovascular risk in general population (8) and poor prognosis in patients with COPD (9) .Atherosclerosis is the principal cause of coronary heart disease, stroke and peripheral vascular disease (10) . Subclinical carotid atherosclerosis is reported to correlate well with coronary and intracranial atherosclerosis and therefore a predictor of further cardiovascular events (11) .Carotid Intima- Media Thickness (IMT) and atheromatous plaque