학술논문
The Association Between Lung Hyperinflation and Coronary Artery Disease in Smokers.
Document Type
Academic Journal
Author
Chandra D; Department of Medicine, University of Pittsburgh, Pittsburgh, PA.; Gupta A; Department of Medicine, University of Pittsburgh, Pittsburgh, PA.; Kinney GL; Department of Epidemiology, University of Colorado, Denver, CO.; Fuhrman CR; Department of Radiology, University of Pittsburgh, Pittsburgh, PA.; Leader JK; Department of Radiology, University of Pittsburgh, Pittsburgh, PA.; Diaz AA; Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.; Bon J; Department of Medicine, University of Pittsburgh, Pittsburgh, PA.; Barr RG; Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY.; Washko G; Pulmonary and Critical Care Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.; Budoff M; Department of Medicine, University of California at Los Angeles, Los Angeles, CA.; Hokanson J; Department of Epidemiology, University of Colorado, Denver, CO.; Sciurba FC; Department of Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: sciurbafc@upmc.edu.
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 0231335 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1931-3543 (Electronic) Linking ISSN: 00123692 NLM ISO Abbreviation: Chest Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Smokers manifest varied phenotypes of pulmonary impairment.
Research Question: Which pulmonary phenotypes are associated with coronary artery disease (CAD) in smokers?
Study Design and Methods: We analyzed data from the University of Pittsburgh COPD Specialized Center for Clinically Oriented Research (SCCOR) cohort (n = 481) and the Genetic Epidemiology of COPD (COPDGene) cohort (n = 2,580). Participants were current and former smokers with > 10 pack-years of tobacco exposure. Data from the two cohorts were analyzed separately because of methodologic differences. Lung hyperinflation was assessed by plethysmography in the SCCOR cohort and by inspiratory and expiratory CT scan lung volumes in the COPDGene cohort. Subclinical CAD was assessed as the coronary artery calcium score, whereas clinical CAD was defined as a self-reported history of CAD or myocardial infarction (MI). Analyses were performed in all smokers and then repeated in those with airflow obstruction (FEV1 to FVC ratio, < 0.70).
Results: Pulmonary phenotypes, including airflow limitation, emphysema, lung hyperinflation, diffusion capacity, and radiographic measures of airway remodeling, showed weak to moderate correlations (r < 0.7) with each other. In multivariate models adjusted for pulmonary phenotypes and CAD risk factors, lung hyperinflation was the only phenotype associated with calcium score, history of clinical CAD, or history of MI (per 0.2 higher expiratory and inspiratory CT scan lung volume; coronary calcium: OR, 1.2; 95% CI, 1.1-1.5; P = .02; clinical CAD: OR, 1.6; 95% CI, 1.1-2.3; P = .01; and MI in COPDGene: OR, 1.7; 95% CI, 1.0-2.8; P = .05). FEV1 and emphysema were associated with increased risk of CAD (P < .05) in models adjusted for CAD risk factors; however, these associations were attenuated on adjusting for lung hyperinflation. Results were the same in those with airflow obstruction and were present in both cohorts.
Interpretation: Lung hyperinflation is associated strongly with clinical and subclinical CAD in smokers, including those with airflow obstruction. After lung hyperinflation was accounted for, FEV1 and emphysema no longer were associated with CAD. Subsequent studies should consider measuring lung hyperinflation and examining its mechanistic role in CAD in current and former smokers.
(Copyright © 2021. Published by Elsevier Inc.)
Research Question: Which pulmonary phenotypes are associated with coronary artery disease (CAD) in smokers?
Study Design and Methods: We analyzed data from the University of Pittsburgh COPD Specialized Center for Clinically Oriented Research (SCCOR) cohort (n = 481) and the Genetic Epidemiology of COPD (COPDGene) cohort (n = 2,580). Participants were current and former smokers with > 10 pack-years of tobacco exposure. Data from the two cohorts were analyzed separately because of methodologic differences. Lung hyperinflation was assessed by plethysmography in the SCCOR cohort and by inspiratory and expiratory CT scan lung volumes in the COPDGene cohort. Subclinical CAD was assessed as the coronary artery calcium score, whereas clinical CAD was defined as a self-reported history of CAD or myocardial infarction (MI). Analyses were performed in all smokers and then repeated in those with airflow obstruction (FEV
Results: Pulmonary phenotypes, including airflow limitation, emphysema, lung hyperinflation, diffusion capacity, and radiographic measures of airway remodeling, showed weak to moderate correlations (r < 0.7) with each other. In multivariate models adjusted for pulmonary phenotypes and CAD risk factors, lung hyperinflation was the only phenotype associated with calcium score, history of clinical CAD, or history of MI (per 0.2 higher expiratory and inspiratory CT scan lung volume; coronary calcium: OR, 1.2; 95% CI, 1.1-1.5; P = .02; clinical CAD: OR, 1.6; 95% CI, 1.1-2.3; P = .01; and MI in COPDGene: OR, 1.7; 95% CI, 1.0-2.8; P = .05). FEV
Interpretation: Lung hyperinflation is associated strongly with clinical and subclinical CAD in smokers, including those with airflow obstruction. After lung hyperinflation was accounted for, FEV
(Copyright © 2021. Published by Elsevier Inc.)