Linking Lungs and Heart: Centrilobular Emphysema and Coronary Artery Calcification Progression Over 18 Years of...

Low-dose CT (LDCT) imaging of the chest for lung cancer screening provides an opportunity to evaluate smoking-related comorbidities such as emphysema and coronary artery calcification (CAC). Although cross-sectional associations exist, the long-term relationship between emphysema subtypes and CAC progression remains undefined.

Is any emphysema subtype associated with long-term CAC progression?

A total of 256 participants with ≥ 15 years of follow-up were included from a prospective cohort of 9,047 asymptomatic, high-risk individuals enrolled in the Mount Sinai Early Lung and Cardiac Action Program (New York, June 2000-August 2004). Emphysema and its 2 subtypes-centrilobular (CLE) emphysema and paraseptal emphysema (PSE)-were assessed visually and graded using an enhanced Fleischner Society classification. CAC was scored using a validated ordinal method. Progression was defined as any increase in total score from baseline to follow-up. Logistic regression was used to identify predictors of CAC progression, including CLE and PSE progression, adjusted for age, smoking status, and pack-years of smoking.

Among 256 participants (50% female and 50% male; median age, 58 years [interquartile range (IQR), 52-63]), most participants (69.1%) had a history of former smoking at enrollment, with a median of 31.1 pack-years of smoking (IQR, 21-49 pack-years). Progression of CAC and emphysema was observed in 182 participants (71.7%) and 145 participants (56.6%), respectively, over a median follow-up of 18.3 years (IQR, 16.7-20.5 years). Participants with CAC progression showed significantly higher rates of any emphysema both at baseline (70.9% vs 54.2%; P = .011) and at follow-up (75.8% vs 56.9%; P = .003). This group also showed higher median CLE scores at baseline (2.00 vs 0.00; P < .001) and follow-up (5.00 vs 0.00; P < .001). In multivariable logistic regression adjusted for age, smoking status, and pack-years of smoking, CLE progression was associated strongly with CAC progression (OR, 3.32; 95% CI, 1.75-6.63; P < .001). In contrast, PSE showed no significant association with CAC progression (OR, 1.17; 95% CI, 0.32-5.64; P = .83).

Our results show that in this long-term screening cohort, progression of CLE-but not PSE-was linked to CAC progression, highlighting the value of detailed emphysema assessment in screening programs and supporting CLE as a systemic disorder with prognostic relevance.