Related Experiment Video
Updated: Jun 18, 2025
Author Spotlight: Evaluating the Therapeutic Efficacy of Moving Cupping Along Meridians for Acute Exacerbation of COPD
Published on: September 27, 2024
Differential Association of COPD Subtypes With Cardiovascular Events and COPD Exacerbations
Han-Mo Yang1, Min Hyung Ryu2, Vincent J Carey2
1Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Insights
Chest CT scan parameters, coronary artery calcium score (CACS) and pulmonary artery to aorta ratio (PA:A), predict cardiovascular events and COPD exacerbations. These predictors show stronger associations in non-emphysema-predominant COPD.
Area of Science:
- Cardiovascular Imaging and Diagnostics
- Pulmonary Medicine and Imaging
- Chronic Obstructive Pulmonary Disease (COPD) Research
Background:
- Coronary artery calcium score (CACS) and pulmonary artery to aorta diameter ratio (PA:A ratio) are established predictors for cardiovascular events and COPD exacerbations, respectively.
- The interplay between these CT-derived predictors and clinical outcomes, particularly across different COPD subtypes, remains underexplored.
- Characterizing the prognostic impact of COPD subtypes on clinical outcomes is crucial for personalized risk assessment.
Purpose of the Study:
- To investigate the predictive capabilities of CACS and PA:A ratio for subsequent cardiovascular events and COPD exacerbations.
- To analyze these predictive relationships within distinct subtypes of COPD.
- To determine if COPD subtypes modify the association between CT-derived parameters and clinical outcomes.
Main Methods:
- Utilized data from the COPDGene study, including participants with COPD (GOLD spirometric grades 2-4).
- Assessed prospective risks for cardiovascular disease (CVD) and COPD exacerbations using logistic regression models based on CACS and PA:A ratio.
- Categorized participants into three COPD subtypes: non-emphysema-predominant COPD (NEPD), emphysema-predominant COPD (EPD), and intermediate emphysema COPD (IE).
Main Results:
- Higher CACS (≥ median) was significantly associated with increased cardiovascular event risk (OR, 1.61).
- Higher PA:A ratio (≥ 1) was significantly associated with increased COPD exacerbation risk (OR, 1.80).
- Participants with NEPD demonstrated stronger associations between CACS/CVD and PA:A ratio/COPD exacerbations compared to EPD, with a statistically significant difference for CACS/CVD.
Conclusions:
- CACS and PA:A ratio are distinct predictors of cardiovascular events and COPD exacerbations, respectively.
- The predictive value of these CT-derived parameters is influenced by COPD subtype.
- Non-emphysema-predominant COPD may confer a heightened risk associated with these imaging biomarkers.
Background:
The coronary artery calcium score (CACS) and ratio of the pulmonary artery to aorta diameters (PA:A ratio) measured from chest CT scans have been established as predictors of cardiovascular events and COPD exacerbations, respectively. However, little is known about the reciprocal relationship between these predictors and outcomes. Furthermore, the prognostic implications of COPD subtypes on clinical outcomes remain insufficiently characterized.
Research Question:
How can these two chest CT scan-derived parameters predict subsequent cardiovascular events and COPD exacerbations in different COPD subtypes?
Study Design And Methods:
Using COPDGene study data, we assessed prospective cardiovascular disease (CVD) and COPD exacerbation risk in participants with COPD (Global Initiative for Chronic Obstructive Lung Disease spirometric grades 2-4), focusing on CACS and PA:A ratio at study enrollment, with logistic regression models. These outcomes were analyzed in three COPD subtypes: 1,042 participants with non-emphysema-predominant COPD (NEPD; low attenuation area at -950 Hounsfield units [LAA-950] < 5%), 1,324 participants with emphysema-predominant COPD (EPD; LAA-950 ≥ 10%), and 465 participants with intermediate emphysema COPD (IE; 5% ≤ LAA-950 < 10%).
Results:
Our study indicated significantly higher overall risk for cardiovascular events in participants with higher CACS (≥ median; OR, 1.61; 95% CI, 1.30-2.00) and increased COPD exacerbations in those with higher PA:A ratios (≥ 1; OR, 1.80; 95% CI, 1.46-2.23). Notably, participants with NEPD showed a stronger association between these indicators and clinical events compared to EPD (with CACS/CVD, NEPD vs EPD: OR, 2.02 vs 1.41; with PA:A ratio/COPD exacerbation, NEPD vs EPD: OR, 2.50 vs 1.65); the difference in ORs between COPD subtypes was statistically significant for CACS/CVD.
Interpretation:
Two chest CT scan parameters, CACS and PA:A ratio, hold distinct predictive values for cardiovascular events and COPD exacerbations that are influenced by specific COPD subtypes.
Trial Registration:
ClinicalTrials.gov; No.: NCT00608764; URL: www.
Clinicaltrials:
gov.
Related Concept Videos
01:20COPD: Pathogenesis and Clinical Features
The primary cause for the onset of COPD is cigarette smoking and exposure to air pollution. These hazardous factors initiate a chain reaction within the lungs, resulting in chronic inflammation, damage to the airways, and a...
01:22Chronic Obstructive Pulmonary Disease
Smoking is a primary risk factor for COPD, with over 80% of patients having a history of it. Patients typically experience progressive dyspnea or labored breathing, frequent coughing, and recurrent pulmonary infections. Many eventually succumb to respiratory failure, characterized by...
01:20Chronic Obstructive Pulmonary Disease-I: Introduction
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:20Chronic Obstructive Pulmonary Disease-II: Pathophysiology
Chronic Inflammation
01:25Chronic Obstructive Pulmonary Disease-III: Symptoms and Complications.
Symptoms of COPD can be classified as primary or systemic. Primary symptoms relate to reduced airflow, while systemic or extrapulmonary symptoms relate to COPD's broader impact on the body.
Primary Symptoms of COPD: