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Updated: May 3, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and
Michelle C Williams1, John T Murchison2, Lisa D Edwards3
1University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK.
Insights
Patients with chronic obstructive pulmonary disease (COPD) have significantly higher coronary artery calcification (CAC) than controls. This increased CAC is linked to worse symptoms, reduced exercise capacity, and higher mortality in COPD patients.
Area of Science:
- Cardiology
- Pulmonology
- Medical Imaging
Background:
- Coronary artery disease (CAD) is indicated by coronary artery calcification.
- The relationship between CAD, lung function, functional capacity, and clinical outcomes in patients with chronic obstructive pulmonary disease (COPD) remains unclear.
- This study investigates the association between CAD and disease severity, functional capacity, and outcomes in COPD patients.
Purpose of the Study:
- To assess the association between coronary artery calcification score (CACS) and disease severity in COPD patients.
- To evaluate the link between CACS and functional capacity in individuals with COPD.
- To determine the relationship between CACS and clinical outcomes, including mortality, in COPD patients.
Main Methods:
- Coronary artery calcium score (CACS) was measured using chest CT scans.
- Data were analyzed from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study.
- Participants included patients with COPD, smokers with normal spirometry, and non-smokers.
Main Results:
- Patients with COPD exhibited significantly higher CACS compared to smokers and non-smokers (p<0.001).
- In COPD patients, CACS correlated with age, smoking history, 6-minute walking distance, dyspnea score, and inflammatory markers (IL-6, IL-8).
- Higher CACS was observed in COPD patients who died within 3 years, and it was independently associated with mortality (p=0.036).
Conclusions:
- COPD patients demonstrate a higher prevalence of CAD compared to control groups.
- Increased CAD in COPD is associated with greater dyspnea, diminished exercise capacity, and elevated mortality risk.
- The presence of CAD in COPD patients signifies poorer clinical outcomes and warrants further investigation.
Background:
Coronary artery calcification is pathognomonic of coronary artery disease (CAD). Whether CAD in patients with COPD is linked to lung function, functional capacity and/or clinically relevant outcomes is unknown. The objective was to assess the association between CAD and disease severity, functional capacity and outcomes in patients with COPD.
Methods:
Coronary artery calcium score (CACS; Agatston score) was measured using chest CT in patients with COPD, smokers with normal spirometry and non-smokers from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study.
Results:
CACS was measured in 942 subjects: 672 with COPD (mean age±SD, 63±7 years; FEV1 49±16% predicted), 199 smokers with normal spirometry (54±9 years; FEV1 110±12% predicted) and 71 non-smokers (55±9 years; FEV1 114±14% predicted). CACS was higher in patients with COPD than smokers or non-smokers (median (IQR), 128 (492) vs 0 (75) vs 0 (3) Agatston units (AU), p<0.001). In patients with COPD, CACS correlated with age, pack-years, 6 min walking distance, modified Medical Research Council Dyspnoea score and circulating levels of interleukin (IL)-6, IL-8, Clara Cell protein 16, surfactant protein D and peripheral blood neutrophil count, but not with emphysema, exacerbation frequency, % predicted FEV1 or decline in FEV1. CACS was higher in patients with COPD who died than in those who survived until 3-year follow-up (CACS 406 vs 103 AU, p<0.001), and was associated with mortality in a Cox proportional hazards model (p=0.036).
Conclusions:
Patients with COPD have more CAD than controls and this is associated with increased dyspnoea, reduced exercise capacity and increased mortality. These data indicate that the presence of CAD in patients with COPD is associated with poor clinical outcomes.
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