title: Coronary artery calcification, epicardial fat burden, and cardiovascular events in chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Patients with chronic obstructive pulmonary disease (COPD) suffer from significantly more cardiovascular comorbidity and mortality than would be anticipated from conventional risk factors. The aim of this study was to determine whether COPD patients have a higher coronary artery calcium score (CACS) and epicardial fat burden, compared to control subjects, and their association with cardiovascular events.
  
  
  METHODS
  From a registry of 1906 patients 81 patients with clinically diagnosed COPD were one-to-one matched to 81 non-COPD control subjects with a smoking history, according to their age, sex, and the number of classic cardiovascular risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, family history of premature coronary artery disease). CACS, epicardial fat, and subsequent major adverse cardiovascular events (MACE) during follow-up were compared between groups.
  
  
  RESULTS
  Patients with COPD (Global Initiative for Chronic Obstructive Lung Disease-classification I: 5%, II: 23%, III: 16% and IV: 56%) showed no difference in CACS (median difference 68 Agatston Units [95% confidence interval -176.5 to 192.5], p=0.899) or epicardial fat volume (mean difference -0.5 cm3 [95% confidence interval -20.9 to 21.9], p=0.961) compared with controls. After a median follow-up of 42.6 months a higher incidence of MACE was observed in COPD patients (RR=2.80, p=0.016) compared with controls. Cox proportional hazard regression identified cardiac ischemias and CACS as independent predictors for MACE.
  
  
  CONCLUSIONS
  COPD patients experienced a higher MACE incidence compared to controls despite no baseline differences in coronary calcification and epicardial fat burden. Other mechanisms such as undersupply of medication seem to account for an excess cardiovascular comorbidity in COPD patients.
authors.affiliation: Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaisl
authors.affiliation: Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Schlatzer
authors.affiliation: Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Esther I
authors.initials: EI
authors.lastname: Schwarz
authors.affiliation: Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Mathias
authors.initials: M
authors.lastname: Possner
authors.affiliation: Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Julia
authors.initials: J
authors.lastname: Stehli
authors.affiliation: Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Noriane A
authors.initials: NA
authors.lastname: Sievi
authors.affiliation: Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Christian F
authors.initials: CF
authors.lastname: Clarenbach
authors.affiliation: Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
authors.forename: Damini
authors.initials: D
authors.lastname: Dey
authors.affiliation: Departments of Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
authors.forename: Piotr J
authors.initials: PJ
authors.lastname: Slomka
authors.affiliation: Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Kaufmann
authors.affiliation: Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland; Zurich Centre for Integrative Human Physiology, University of Zurich, Zurich, Switzerland; Centre for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Kohler
mesh_terms: D050154:Adiposity; D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging; D002118:Calcium / Q000378:metabolism; D009202:Cardiomyopathies / Q000150:complications* / Q000000981:diagnostic imaging; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010496:Pericardium / Q000000981:diagnostic imaging / Q000473:pathology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000000981:diagnostic imaging; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D002118:Calcium