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Relationship between chronic obstructive pulmonary disease and subclinical coronary artery disease in long-term
Thomas Rasmussen1, Lars Køber, Jesper Holst Pedersen
1Department of Cardiology, Section 2012, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Insights
Chronic obstructive pulmonary disease (COPD) in long-term smokers is linked to coronary artery calcification (CAC). However, COPD severity does not correlate with increased CAC, suggesting CAC is an independent risk factor.
Area of Science:
- Cardiology
- Pulmonology
- Radiology
Background:
- Cardiovascular disease is a leading cause of mortality in COPD patients.
- The independent association between COPD severity and coronary artery disease (CAD) remains unclear.
- Coronary artery calcium deposit (CAC) is a key indicator of subclinical CAD.
Purpose of the Study:
- To investigate the relationship between COPD presence and severity with CAC in long-term smokers.
- To determine if COPD is an independent predictor of CAD, beyond traditional risk factors.
Main Methods:
- Cross-sectional study of 1535 long-term smokers from the Danish Lung Cancer Screening Trial.
- COPD classification using Global Initiative for Obstructive Lung Disease (GOLD) criteria.
- Coronary artery calcium scoring (CACS) via multi-detector computed tomography to assess subclinical CAD.
Main Results:
- COPD was an independent predictor of higher CACS risk classification (OR: 1.28 for mild, 1.32 for moderate-to-severe COPD).
- Traditional risk factors (age, male gender, hypertension, hypercholesterolemia, smoking) also predicted higher CACS.
- No dose-response relationship was observed between COPD severity and CACS.
Conclusions:
- COPD is independently associated with coronary artery calcification in long-term smokers.
- COPD severity does not correlate with CAC in a dose-dependent manner.
Aims:
Cardiovascular conditions are reported to be the most frequent cause of death in patients with chronic obstructive pulmonary disease (COPD). However, it remains unsettled whether severity of COPD per se is associated with coronary artery disease (CAD) independent of traditional cardiovascular risk factors. The aim of this study was to examine the relationship between the presence and severity of COPD and the amount of coronary artery calcium deposit, an indicator of CAD and cardiac risk, in a large population of current and former long-term smokers.
Methods And Results:
In this cross-sectional study, long-term smokers without clinically manifested CAD were recruited from the Danish Lung Cancer Screening Trial and classified according to lung function by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Coronary artery calcium deposit as a measure of subclinical CAD and cardiac risk was evaluated with multi detector computed tomography and the Agatston coronary artery calcium score (CACS). Participants were categorized into five CACS risk classification groups according to the CACS. The population (n = 1535) consisted of 41% participants without COPD, 28% with mild, and 31% with moderate-to-severe COPD (n = 46 with severe COPD). In addition to age, male gender, hypertension, hypercholesterolaemia, and continued smoking, COPD according to GOLD classification were independent predictors of a higher CACS risk classification group in multivariable analysis [odds ratio (OR): 1.28 (1.01-1.63) and OR: 1.32 (1.05-1.67), for mild and moderate-to-severe COPD, respectively, compared with no COPD].
Conclusion:
COPD in long-term smokers is independently correlated with the CACS, while COPD severity per se does not show a dose-response relationship.
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