Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality

Michelle C. Williams, John T. Murchison, Lisa D. Edwards, Alvar Agustí, Per Bakke, Peter M.A. Calverley, Bartolome Celli, Harvey O. Coxson, Courtney Crim, David A. Lomas, Bruce E. Miller, Steve Rennard, Edwin K. Silverman, Ruth Tal-Singer, Jørgen Vestbo, Emiel Wouters, Julie C. Yates, Edwin J.R. Van Beek, David E. Newby, William MacNee

Research output: Contribution to journalArticle

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Abstract

Background Coronary artery calcification is pathognomonic of coronary artery disease (CAD). Whether CAD in patients with COPD is linked to lung function, functional capacity and/or clinically relevant outcomes is unknown. The objective was to assess the association between CAD and disease severity, functional capacity and outcomes in patients with COPD. Methods Coronary artery calcium score (CACS; Agatston score) was measured using chest CT in patients with COPD, smokers with normal spirometry and nonsmokers from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study. Results CACS was measured in 942 subjects: 672 with COPD (mean age±SD, 63±7 years; FEV1 49±16% predicted), 199 smokers with normal spirometry (54 ±9 years; FEV1 110±12% predicted) and 71 nonsmokers (55±9 years; FEV1 114±14% predicted). CACS was higher in patients with COPD than smokers or non-smokers (median (IQR), 128 (492) vs 0 (75) vs 0 (3) Agatston units (AU), p<0.001). In patients with COPD, CACS correlated with age, pack-years, 6 min walking distance, modified Medical Research Council Dyspnoea score and circulating levels of interleukin (IL)-6, IL-8, Clara Cell protein 16, surfactant protein D and peripheral blood neutrophil count, but not with emphysema, exacerbation frequency, % predicted FEV1 or decline in FEV1. CACS was higher in patients with COPD who died than in those who survived until 3-year follow-up (CACS 406 vs 103 AU, p<0.001), and was associated with mortality in a Cox proportional hazards model (p=0.036). Conclusions Patients with COPD have more CAD than controls and this is associated with increased dyspnoea, reduced exercise capacity and increased mortality. These data indicate that the presence of CAD in patients with COPD is associated with poor clinical outcomes.

Original languageEnglish (US)
Pages (from-to)718-723
Number of pages6
JournalThorax
Volume69
Issue number8
DOIs
StatePublished - Aug 2014

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Chronic Obstructive Pulmonary Disease
Coronary Vessels
Morbidity
Mortality
Coronary Artery Disease
Spirometry
Dyspnea
Pulmonary Surfactant-Associated Protein D
Emphysema
Interleukin-8
Proportional Hazards Models
Walking
Biomedical Research
Interleukin-6
Neutrophils
Thorax
Biomarkers
Exercise
Calcium
Lung

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Williams, M. C., Murchison, J. T., Edwards, L. D., Agustí, A., Bakke, P., Calverley, P. M. A., ... MacNee, W. (2014). Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality. Thorax, 69(8), 718-723. https://doi.org/10.1136/thoraxjnl-2012-203151

Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality. / Williams, Michelle C.; Murchison, John T.; Edwards, Lisa D.; Agustí, Alvar; Bakke, Per; Calverley, Peter M.A.; Celli, Bartolome; Coxson, Harvey O.; Crim, Courtney; Lomas, David A.; Miller, Bruce E.; Rennard, Steve; Silverman, Edwin K.; Tal-Singer, Ruth; Vestbo, Jørgen; Wouters, Emiel; Yates, Julie C.; Van Beek, Edwin J.R.; Newby, David E.; MacNee, William.

In: Thorax, Vol. 69, No. 8, 08.2014, p. 718-723.

Research output: Contribution to journalArticle

Williams, MC, Murchison, JT, Edwards, LD, Agustí, A, Bakke, P, Calverley, PMA, Celli, B, Coxson, HO, Crim, C, Lomas, DA, Miller, BE, Rennard, S, Silverman, EK, Tal-Singer, R, Vestbo, J, Wouters, E, Yates, JC, Van Beek, EJR, Newby, DE & MacNee, W 2014, 'Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality', Thorax, vol. 69, no. 8, pp. 718-723. https://doi.org/10.1136/thoraxjnl-2012-203151
Williams, Michelle C. ; Murchison, John T. ; Edwards, Lisa D. ; Agustí, Alvar ; Bakke, Per ; Calverley, Peter M.A. ; Celli, Bartolome ; Coxson, Harvey O. ; Crim, Courtney ; Lomas, David A. ; Miller, Bruce E. ; Rennard, Steve ; Silverman, Edwin K. ; Tal-Singer, Ruth ; Vestbo, Jørgen ; Wouters, Emiel ; Yates, Julie C. ; Van Beek, Edwin J.R. ; Newby, David E. ; MacNee, William. / Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality. In: Thorax. 2014 ; Vol. 69, No. 8. pp. 718-723.
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abstract = "Background Coronary artery calcification is pathognomonic of coronary artery disease (CAD). Whether CAD in patients with COPD is linked to lung function, functional capacity and/or clinically relevant outcomes is unknown. The objective was to assess the association between CAD and disease severity, functional capacity and outcomes in patients with COPD. Methods Coronary artery calcium score (CACS; Agatston score) was measured using chest CT in patients with COPD, smokers with normal spirometry and nonsmokers from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study. Results CACS was measured in 942 subjects: 672 with COPD (mean age±SD, 63±7 years; FEV1 49±16{\%} predicted), 199 smokers with normal spirometry (54 ±9 years; FEV1 110±12{\%} predicted) and 71 nonsmokers (55±9 years; FEV1 114±14{\%} predicted). CACS was higher in patients with COPD than smokers or non-smokers (median (IQR), 128 (492) vs 0 (75) vs 0 (3) Agatston units (AU), p<0.001). In patients with COPD, CACS correlated with age, pack-years, 6 min walking distance, modified Medical Research Council Dyspnoea score and circulating levels of interleukin (IL)-6, IL-8, Clara Cell protein 16, surfactant protein D and peripheral blood neutrophil count, but not with emphysema, exacerbation frequency, {\%} predicted FEV1 or decline in FEV1. CACS was higher in patients with COPD who died than in those who survived until 3-year follow-up (CACS 406 vs 103 AU, p<0.001), and was associated with mortality in a Cox proportional hazards model (p=0.036). Conclusions Patients with COPD have more CAD than controls and this is associated with increased dyspnoea, reduced exercise capacity and increased mortality. These data indicate that the presence of CAD in patients with COPD is associated with poor clinical outcomes.",
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T1 - Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality

AU - Williams, Michelle C.

AU - Murchison, John T.

AU - Edwards, Lisa D.

AU - Agustí, Alvar

AU - Bakke, Per

AU - Calverley, Peter M.A.

AU - Celli, Bartolome

AU - Coxson, Harvey O.

AU - Crim, Courtney

AU - Lomas, David A.

AU - Miller, Bruce E.

AU - Rennard, Steve

AU - Silverman, Edwin K.

AU - Tal-Singer, Ruth

AU - Vestbo, Jørgen

AU - Wouters, Emiel

AU - Yates, Julie C.

AU - Van Beek, Edwin J.R.

AU - Newby, David E.

AU - MacNee, William

PY - 2014/8

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N2 - Background Coronary artery calcification is pathognomonic of coronary artery disease (CAD). Whether CAD in patients with COPD is linked to lung function, functional capacity and/or clinically relevant outcomes is unknown. The objective was to assess the association between CAD and disease severity, functional capacity and outcomes in patients with COPD. Methods Coronary artery calcium score (CACS; Agatston score) was measured using chest CT in patients with COPD, smokers with normal spirometry and nonsmokers from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study. Results CACS was measured in 942 subjects: 672 with COPD (mean age±SD, 63±7 years; FEV1 49±16% predicted), 199 smokers with normal spirometry (54 ±9 years; FEV1 110±12% predicted) and 71 nonsmokers (55±9 years; FEV1 114±14% predicted). CACS was higher in patients with COPD than smokers or non-smokers (median (IQR), 128 (492) vs 0 (75) vs 0 (3) Agatston units (AU), p<0.001). In patients with COPD, CACS correlated with age, pack-years, 6 min walking distance, modified Medical Research Council Dyspnoea score and circulating levels of interleukin (IL)-6, IL-8, Clara Cell protein 16, surfactant protein D and peripheral blood neutrophil count, but not with emphysema, exacerbation frequency, % predicted FEV1 or decline in FEV1. CACS was higher in patients with COPD who died than in those who survived until 3-year follow-up (CACS 406 vs 103 AU, p<0.001), and was associated with mortality in a Cox proportional hazards model (p=0.036). Conclusions Patients with COPD have more CAD than controls and this is associated with increased dyspnoea, reduced exercise capacity and increased mortality. These data indicate that the presence of CAD in patients with COPD is associated with poor clinical outcomes.

AB - Background Coronary artery calcification is pathognomonic of coronary artery disease (CAD). Whether CAD in patients with COPD is linked to lung function, functional capacity and/or clinically relevant outcomes is unknown. The objective was to assess the association between CAD and disease severity, functional capacity and outcomes in patients with COPD. Methods Coronary artery calcium score (CACS; Agatston score) was measured using chest CT in patients with COPD, smokers with normal spirometry and nonsmokers from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study. Results CACS was measured in 942 subjects: 672 with COPD (mean age±SD, 63±7 years; FEV1 49±16% predicted), 199 smokers with normal spirometry (54 ±9 years; FEV1 110±12% predicted) and 71 nonsmokers (55±9 years; FEV1 114±14% predicted). CACS was higher in patients with COPD than smokers or non-smokers (median (IQR), 128 (492) vs 0 (75) vs 0 (3) Agatston units (AU), p<0.001). In patients with COPD, CACS correlated with age, pack-years, 6 min walking distance, modified Medical Research Council Dyspnoea score and circulating levels of interleukin (IL)-6, IL-8, Clara Cell protein 16, surfactant protein D and peripheral blood neutrophil count, but not with emphysema, exacerbation frequency, % predicted FEV1 or decline in FEV1. CACS was higher in patients with COPD who died than in those who survived until 3-year follow-up (CACS 406 vs 103 AU, p<0.001), and was associated with mortality in a Cox proportional hazards model (p=0.036). Conclusions Patients with COPD have more CAD than controls and this is associated with increased dyspnoea, reduced exercise capacity and increased mortality. These data indicate that the presence of CAD in patients with COPD is associated with poor clinical outcomes.

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