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Published on: August 28, 2018
Coronary artery calcification, epicardial fat burden, and cardiovascular events in chronic obstructive pulmonary
Thomas Gaisl1, Christian Schlatzer1, Esther I Schwarz1
1Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
Insights
Chronic obstructive pulmonary disease (COPD) patients face higher cardiovascular event risks, despite similar coronary artery calcium scores and epicardial fat to controls. This suggests other factors contribute to their increased cardiovascular comorbidity.
Area of Science:
- Cardiology
- Pulmonology
- Medical Imaging
Background:
- Patients with chronic obstructive pulmonary disease (COPD) exhibit elevated cardiovascular comorbidity and mortality.
- Conventional risk factors do not fully explain the increased cardiovascular burden in COPD patients.
Purpose of the Study:
- To compare coronary artery calcium score (CACS) and epicardial fat volume between COPD patients and controls.
- To investigate the association of CACS and epicardial fat with major adverse cardiovascular events (MACE) in COPD patients.
Main Methods:
- Matched cohort study comparing 81 COPD patients with 81 non-COPD controls based on age, sex, and cardiovascular risk factors.
- Assessment of CACS, epicardial fat volume, and MACE during a median follow-up of 42.6 months.
Main Results:
- No significant differences in CACS or epicardial fat volume were found between COPD patients and controls.
- COPD patients exhibited a significantly higher incidence of MACE (RR=2.80, p=0.016) compared to controls.
- Cardiac ischemia and CACS were identified as independent predictors of MACE.
Conclusions:
- COPD patients have a higher incidence of MACE despite similar baseline coronary calcification and epicardial fat.
- Mechanisms beyond coronary calcification and epicardial fat, potentially including medication undersupply, contribute to excess cardiovascular risk in COPD.
Rationale:
Patients with chronic obstructive pulmonary disease (COPD) suffer from significantly more cardiovascular comorbidity and mortality than would be anticipated from conventional risk factors. The aim of this study was to determine whether COPD patients have a higher coronary artery calcium score (CACS) and epicardial fat burden, compared to control subjects, and their association with cardiovascular events.
Methods:
From a registry of 1906 patients 81 patients with clinically diagnosed COPD were one-to-one matched to 81 non-COPD control subjects with a smoking history, according to their age, sex, and the number of classic cardiovascular risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, family history of premature coronary artery disease). CACS, epicardial fat, and subsequent major adverse cardiovascular events (MACE) during follow-up were compared between groups.
Results:
Patients with COPD (Global Initiative for Chronic Obstructive Lung Disease-classification I: 5%, II: 23%, III: 16% and IV: 56%) showed no difference in CACS (median difference 68 Agatston Units [95% confidence interval -176.5 to 192.5], p=0.899) or epicardial fat volume (mean difference -0.5 cm3 [95% confidence interval -20.9 to 21.9], p=0.961) compared with controls. After a median follow-up of 42.6 months a higher incidence of MACE was observed in COPD patients (RR=2.80, p=0.016) compared with controls. Cox proportional hazard regression identified cardiac ischemias and CACS as independent predictors for MACE.
Conclusion:
COPD patients experienced a higher MACE incidence compared to controls despite no baseline differences in coronary calcification and epicardial fat burden. Other mechanisms such as undersupply of medication seem to account for an excess cardiovascular comorbidity in COPD patients.
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