In addition to excess levels of smoking and elevated concentrations of C-reactive protein, several additional physiological disruptions may contribute to the increased risk for cardiovascular disease in people with COPD including increased circulating platelet-monocyte aggregates [30], impaired coronary blood flow [31], endothelial dysfunction [32,33], coagulation abnormalities [32], oxidative stress [34], and increased arterial stiffness [35]. This evidence concerns the gene CRP and endothelial dysfunction.