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Published on: August 24, 2019
Factors associated with coronary heart disease in COPD patients and controls
Christina D Svendsen1, Karel K J Kuiper2, Kristoffer Ostridge3,4
1Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
Insights
Patients with chronic obstructive pulmonary disease (COPD) have a higher risk of coronary heart disease (CHD). However, COPD severity and symptoms did not predict coronary artery calcification or stenosis.
Area of Science:
- Cardiology
- Pulmonology
- Radiology
Background:
- Chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) frequently coexist.
- Understanding COPD phenotypes associated with higher CHD risk is crucial.
Purpose of the Study:
- To determine if COPD patients have a higher risk of CHD compared to non-COPD individuals.
- To identify factors associated with CHD in COPD patients and controls.
Main Methods:
- Coronary computed tomography angiography (CCTA) and pulmonary CT were performed on 347 COPD patients and 428 controls.
- Measurements included arterial blood gas, bioelectrical impedance, lung function, and medical history.
- Coronary stenosis and calcium score (CaSc) were evaluated; emphysema was defined by CT criteria.
Main Results:
- COPD patients showed significantly higher rates of coronary stenosis (12.6% vs 5.7%) and CaSc > 100 (55.9% vs 31.6%) compared to controls.
- Adjusted odds ratios indicated COPD patients had higher odds of significant stenosis (1.80) and CaSc > 100 (1.68).
- Within COPD patients, male sex, age, and statin use were associated with higher CaSc, but not stenosis; emphysema, lung function, exacerbations, or hypoxemia did not predict CHD markers.
Conclusions:
- COPD patients exhibit an increased likelihood of developing CHD.
- Specific COPD phenotypes, including emphysema severity, lung function, exacerbation frequency, or hypoxemia, were not found to be predictors of coronary stenosis or calcification.
Background:
COPD and coronary heart disease (CHD) frequently co-occur, yet which COPD phenotypes are most prone to CHD is poorly understood. The aim of this study was to see whether COPD patients did have a true higher risk for CHD than subjects without COPD, and to examine a range of potential factors associated with CHD in COPD patients and controls.
Methods:
347 COPD patients and 428 non-COPD controls, were invited for coronary computed tomography angiography (CCTA) and pulmonary CT. Arterial blood gas, bioelectrical impedance and lung function was measured, and a detailed medical history taken. The CCTA was evaluated for significant coronary stenosis and calcium score (CaSc), and emphysema defined as >10% of total area <-950 Hounsfield units.
Results:
12.6% of the COPD patients and 5.7% of the controls had coronary stenosis (p<0.01), whereas 55.9% of the COPD patients had a CaSc>100 compared to 31.6% of the controls (p<0.01). In a multivariable model adjusting for sex, age, body composition, pack-years, CRP, cholesterol/blood pressure lowering medication use and diabetes mellitus, the OR (95% CI) for having significant stenosis was 1.80 (0.86-3.78) in COPD patients compared with controls. In a similar model, the OR (95% CI) for having CaSc>100 was 1.68 (1.12-2.53) in COPD patients compared with controls. Examining the risk of significant stenosis and CaSc>100 among COPD patients, no variable was associated with significant stenosis, whereas male sex [OR 2.85 (1.56-5.21)], age [OR 3.74 (2.42-5.77)], statin use [OR 2.23 (1.23-4.50)] were associated with CaSc>100, after adjusting for body composition, pack-years, C-reactive protein, use of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), diabetes, emphysema score, GOLD category, exacerbation frequency, eosinophilia, and hypoxemia.
Conclusion:
COPD patients were more likely to have CHD, but neither emphysema score, lung function, exacerbation frequency, nor hypoxemia predicted presence of either coronary stenosis or CaSc>100.
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