Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality.
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 non-smokers 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 non-smokers (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.
University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK.
Michelle C
MC
Williams
Royal Infirmary of Edinburgh, Edinburgh, UK.
John T
JT
Murchison
GlaxoSmithKline, Research Triangle Park, North Carolina, USA.
Lisa D
LD
Edwards
Thorax Institute, Hospital Clinic, Universitat de Barcelona; CIBER Enfermedades Respiratorias (CIBERES), FISIB, Mallorca, Spain.
Alvar
A
Agustí
University of Bergen, Bergen, Norway.
Per
P
Bakke
Department of Respiratory Medicine, University Hospital Aintree, Liverpool, UK.
Peter M A
PM
Calverley
Department of Respiratory Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA.
Bartolome
B
Celli
University of British Columbia, Vancouver, British Columbia, Canada.
Harvey O
HO
Coxson
GlaxoSmithKline, Research Triangle Park, North Carolina, USA.
Courtney
C
Crim
Department of Medicine, University of Cambridge, Cambridge, UK.
David A
DA
Lomas
GlaxoSmithKline, King of Prussia, Pennsylvania, USA.
Bruce E
BE
Miller
University of Nebraska Medical Center, Omaha, Nebraska, USA.
Steve
S
Rennard
Department of Respiratory Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA.
Edwin K
EK
Silverman
GlaxoSmithKline, King of Prussia, Pennsylvania, USA.
Ruth
R
Tal-Singer
Department of Respiratory Medicine, Odense University & University of Southern Denmark, Denmark/University of Manchester, Academic Health Science Centre, Manchester, UK.
Jørgen
J
Vestbo
Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
Emiel
E
Wouters
GlaxoSmithKline, King of Prussia, Pennsylvania, USA.
Julie C
JC
Yates
Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK.
Edwin J R
EJ
van Beek
University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK.
David E
DE
Newby
Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK.
William
W
MacNee
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D004417:Dyspnea / Q000503:physiopathology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D010807:Physical Endurance; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D012129:Respiratory Function Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
D015415:Biomarkers
COPD ÀÜ Mechanisms; Emphysema; Imaging/CT MRI etc