Vascular function changes in the PAT signal are elicited by creating a downstream hyperemic response. A blood pressure cuff was placed above the elbow on one arm, while the contra-lateral arm served as a control arm. Resting

blood pressure was taken before each MVF measurement. The EndoPAT protocol consisted of three recording stages: 5 minute baseline PAT signal measurement, 5 minute occlusion of flow through the brachial artery on the MEK phosphorylation test arm (supra systolic cuff inflation) and 5 minute post-occlusion reactive hyperemia (RH). The response to reactive hyperemia was calculated automatically through a computer algorithm and a RH-PAT index (RHI) was created by the ratio of the post- and pre-occlusion values of the PAT signal. RHI values were normalized to measurements from the control arm. The lung function was measured by spirometry in accordance with the American Thoracic Society/European

Respiratory Society standard guidelines (Miller et al., 2005) using the EasyOne Plus spirometer (ndd Medical Technologies; Zurich Switzerland) as previously described (Karottki et al., 2013). The spirometric measures of forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) were collected after MVF measurements. The data were digitally see more stored and the largest FVC and FEV1 from at least three acceptable trials were used; the ratio of FEV1 to FVC was calculated. On the day of the home visits, peripheral venous blood samples were collected in CPT™ tubes

with sodium heparin (BD Vacutainer® CPT™, Becton Dickinson A/S, Brøndby, Denmark) for peripheral blood mononuclear cell (PBMC) isolation and in EDTA tubes for hematological analyses. Measurements of hemoglobin, and leukocyte counts and their differential profile (lymphocytes, monocytes, neutrophils and eosinophils) were performed by two automatic hematological analyzers, Chempaq (Chempaq XBC, Denmark) and HemoCue (HemoCue AB, Sweden), respectively. The concentration of glycosylated hemoglobin Edoxaban (HbA1c) was determined using the Bio-Rad in2it A1c test cartridges (Bio-Rad, USA). We separated PBMC for storage at − 80 °C in freezing media consisting of 50% fetal bovine serum (FBS, GibcoRBL), 40% culture medium (RPMI 1640, GibcoRBL) and 10% dimetyl sulfoxide for flow cytometry analyses. Plasma CRP, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides were analyzed at the Department of Clinical Biochemistry, Copenhagen University Hospital. Direct immunofluorescence of PBMCs was performed on a BD Accuri™ C6 flow cytometer with BD Accuri CFlow® Plus software (BD Bioscience, Brøndby, Denmark) as previously described (Karottki et al., 2013).