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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Associations Between Coronary Artery Calcium Score and Exacerbation Risk in BLOCK-COPD
R Chad Wade1,2,3,4, Sharon X Ling5, Erika S Helgeson5
1Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States.
Insights
Coronary artery calcium (CAC) scores did not predict exacerbation risk in chronic obstructive pulmonary disease (COPD) patients. However, CAC in the left circumflex artery showed a novel association with increased exacerbation risk.
Area of Science:
- Cardiology
- Pulmonology
- Medical Imaging
Background:
- Coronary artery disease (CAD) is a common comorbidity in patients with chronic obstructive pulmonary disease (COPD), contributing to significant mortality.
- The Beta-Blockers for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease (BLOCK-COPD) study investigated metoprolol's effect on exacerbations in COPD patients without beta-blocker indications.
Purpose of the Study:
- To evaluate if coronary artery calcium (CAC) score, an imaging metric for CAD, predicts exacerbation risk in COPD patients.
- To determine if CAC score identifies a differential response to metoprolol treatment in this population.
Main Methods:
- Utilized data from the BLOCK-COPD study, including participants who underwent thoracic computed tomography (CT) scans.
- Quantified CAC scores using the Weston scoring system and analyzed associations with time to exacerbation using adjusted Cox proportional hazards models.
Main Results:
- In 109 participants, 84% had detectable CAC. Over a median follow-up of 350 days, 61 mild and 19 severe exacerbations occurred.
- No significant associations were found between overall CAC burden and exacerbation risk.
- A novel association was observed between CAC in the left circumflex (LCx) artery and increased risk of any-severity exacerbation (aHR=1.39, p=0.01 for total CAC; aHR=1.96, p=0.04 for CAC>0).
Conclusions:
- While CAC score confirms high CAD prevalence in COPD, it did not predict overall exacerbation risk in this cohort.
- Novel associations between LCx CAC and exacerbation risk warrant further investigation in larger COPD populations.
Introduction:
In 2019, the Beta-Blockers for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease study (BLOCK-COPD) evaluated the effect of metoprolol on exacerbation risk and mortality in a COPD population without indications for beta-blocker use. We hypothesized that an imaging metric of coronary artery disease (CAD), the coronary artery calcium (CAC) score, would predict exacerbation risk and identify a differential response to metoprolol treatment.
Methods:
The study population includes participants in the BLOCK-COPD study from multiple study sites. Participants underwent clinically indicated thoracic computed tomography (CT) scans ± 12 months from enrollment. The Weston scoring system quantified CAC. Adjusted Cox proportional hazards models evaluated for associations between CAC and time to exacerbation.
Results:
Data is included for 109 participants. The mean CAC score was 5.1±3.7, and 92 participants (84%) had CAC scores greater than 0. Over a median (interquartile range) follow-up time of 350 (280 to 352) days, there were 61 mild exacerbations and 19 severe/very severe exacerbations. No associations were found between exacerbations of any severity and CAC>0 or total CAC. Associations were observed between total CAC and CAC>0 in the left circumflex (LCx) and time to exacerbation of any severity (adjusted hazard ratio [aHR]=1.39, confidence interval [CI]: 1.08-1.79, p=0.01) and (aHR=1.96, 95% CI: 1.04-3.70, p=0.04), respectively.
Conclusions:
CAD is a prevalent comorbidity in COPD accounting for significant mortality. Our study confirms the high prevalence of CAD using the CAC score; however, we did not discover an association between CAC and exacerbation risk. We did find novel associations between CAC in the LCx and exacerbation risk which warrant further investigation in larger cohorts.
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