The notion that COPD is associated with a highprevalence of cardiovascular and metabolic diseases isdifficult to refute. Large longitudinal cohort studies haverepeatedly reported the common occurrence ofconcomitant COPD and cardiovascular and metabolicdiseases.1This is a deadly association, as cardiovasculardisease isfirst among the causes of mortality in COPD.2,3One of the most challenging questions about this issue iswhether the concomitant occurrence of COPD andcardiovascular disease is a mere reflection of commonshared risk factors such as tobacco smoking, obesity, orsedentary life style or whether COPD is, by itself, a drivingforce in the development of cardiovascular disease.