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Pulmonary vascular disease in swine with multiple comorbidities

Diabetes mellitus (DM), chronic kidney disease (CKD) and hypercholesterolemia are common co‐morbidities associated with low‐grade inflammation and endothelial dysfunction leading to increased systemic vascular resistance, diastolic dysfunction and exercise intolerance. Diastolic dysfunction is a risk factor for development of post‐capillary pulmonary hypertension (PH), which, in a subgroup of patients, deteriorates into combined pre‐and post‐capillary PH. This process is characterized by an increase in pulmonary vascular resistance (PVR) due to pulmonary vascular dysfunction and remodeling. It is incompletely understood which factors predispose to the development of combined pre‐and post‐capillary PH. We hypothesize that comorbidities cause pulmonary endothelial dysfunction, which in turn initiates pulmonary vascular remodeling, increases PVR and further reduces exercise tolerance.