title: Associations between COPD related manifestations: a cross-sectional study.
abstract: BACKGROUND
  Cardiovascular disease, osteoporosis and emphysema are associated with COPD. Associations between these factors and whether they predict all-cause mortality in COPD patients are not well understood. Therefore, we examined associations between markers of cardiovascular disease (coronary artery calcification [CAC], thoracic aortic calcification [TAC] and arterial stiffness), bone density (bone attenuation of the thoracic vertebrae), emphysema (PI-950 and 15th percentile) and all-cause mortality in a COPD cohort.
  
  
  METHODS
  We assessed CAC, TAC, bone attenuation of the thoracic vertebrae, PI-950 and 15th percentile on low-dose chest computed tomography in COPD subjects. We measured arterial stiffness as carotid-radial pulse wave velocity (PWV), and identified deaths from the national register.
  
  
  RESULTS
  We studied 119 COPD subjects; aged 67.8 ±7.3, 66% were males and mean FEV1% predicted was 46.0 ±17.5. Subjects were classified into three pre-specificed groups: CAC = 0 (n = 14), 0 < CAC ≤ 400 (n = 41) and CAC > 400 (n = 64). Subjects with higher CAC were more likely to be older (p < 0.001) and male (p = 0.03), and more likely to have higher systolic blood pressure (p = 0.001) and a history of hypertension (p = 0.002) or ischemic heart disease (p = 0.003). Higher CAC was associated with higher PWV (OR 1.62, p = 0.04) and lower bone attenuation (OR 0.32, p = 0.02), but not with 15th percentile, after adjustment for age, sex and pack-years of smoking. In a Cox proportional hazards model, CAC, TAC and 15th percentile predicted all-cause mortality (HR 2.01, 2.09 and 0.66, respectively).
  
  
  CONCLUSIONS
  Increased CAC was associated with increased arterial stiffness and lower bone density in a COPD cohort. In addition, CAC, TAC and extent of emphysema predicted all-cause mortality.
  
  
  BACKGROUND
  Lothian NHS Board, Lothian Research Ethics Committee, LREC/2003/8/28.
authors.affiliation: Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands. lisette.romme@catharinaziekenhuis.nl.
authors.forename: Elisabeth A P M
authors.initials: EA
authors.lastname: Romme
authors.forename: David A
authors.initials: DA
authors.lastname: McAllister
authors.forename: John T
authors.initials: JT
authors.lastname: Murchison
authors.forename: Edwin J R
authors.initials: EJ
authors.lastname: Van Beek
authors.forename: George S
authors.initials: GS
authors.lastname: Petrides
authors.forename: Cameron O S
authors.initials: CO
authors.lastname: Price
authors.forename: Erica P A
authors.initials: EP
authors.lastname: Rutten
authors.forename: Frank W J M
authors.initials: FW
authors.lastname: Smeenk
authors.forename: Emiel F M
authors.initials: EF
authors.lastname: Wouters
authors.forename: William
authors.initials: W
authors.lastname: MacNee
mesh_terms: D000368:Aged; D015519:Bone Density / Q000502:physiology; D002114:Calcinosis / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004646:Emphysema / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology* / Q000503:physiopathology; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000401:mortality* / Q000503:physiopathology; D015996:Survival Rate; D059289:Vascular Stiffness / Q000502:physiology