학술논문

The Association Between Lung Hyperinflation and Coronary Artery Disease in Smokers
Document Type
article
Author
Chandra, DivayGupta, AmanKinney, Gregory LFuhrman, Carl RLeader, Joseph KDiaz, Alejandro ABon, JessicaBarr, R GrahamWashko, GeorgeBudoff, MatthewHokanson, JohnSciurba, Frank CCrapo, James DSilverman, Edwin KMake, Barry JRegan, Elizabeth ABeaty, TerriBegum, FerdouseBoueiz, Adel RCastaldi, Peter JCho, MichaelDeMeo, Dawn LForeman, Marilyn GHalper-Stromberg, EitanHayden, Lystra PHersh, Craig PHetmanski, JacquelineHobbs, Brian DHokanson, John ELaird, NanLange, ChristophLutz, Sharon MMcDonald, Merry-LynnParker, Margaret MProkopenko, DmitryQiao, DandiSakornsakolpat, PhuwanatWan, Emily SWon, SunghoQaisi, Mustafa AlCoxson, Harvey OGray, TeresaHan, MeiLan KHoffman, Eric AHumphries, StephenJacobson, Francine LJudy, Philip FKazerooni, Ella AKluiber, AlexLynch, David ANewell, John DRoss, James CSan Jose Estepar, RaulSchroeder, JoyceSieren, JeredStinson, DouglasStoel, Berend CTschirren, JuergVan Beek, Edwinvan Ginneken, Bramvan Rikxoort, EvaWilson, Carla GJensen, RobertCrooks, JimEverett, DouglasMoore, CamilleStrandHughes, JohnKinney, GregoryPratte, KatherineYoung, Kendra ABhatt, SuryaMartinez, CarlosMurray, SusanSoler, XavierBanaei-Kashani, FarnoushBowler, Russell PKechris, KaterinaCurtis, Jeffrey LPernicano, Perry GHanania, NicolaAtik, MustafaBoriek, AladinGuntupalli, KalpathaGuy, ElizabethParulekar, Amit
Source
CHEST Journal. 160(3)
Subject
Biomedical and Clinical Sciences
Cardiovascular Medicine and Haematology
Clinical Sciences
Heart Disease
Genetics
Clinical Research
Emphysema
Lung
Cardiovascular
Biomedical Imaging
Prevention
Tobacco
Chronic Obstructive Pulmonary Disease
Heart Disease - Coronary Heart Disease
Tobacco Smoke and Health
Respiratory
Good Health and Well Being
Airway Obstruction
Airway Remodeling
Asymptomatic Diseases
Biological Variation
Population
Coronary Artery Disease
Coronary Vessels
Female
Humans
Male
Middle Aged
Organ Size
Plethysmography
Pulmonary Emphysema
Respiratory Function Tests
Risk Factors
Smoking
Tomography
X-Ray Computed
United States
COPD
coronary artery disease
lung hyperinflation
smoking
COPDGene Investigators
Respiratory System
Cardiovascular medicine and haematology
Clinical sciences
Language
Abstract
BackgroundSmokers manifest varied phenotypes of pulmonary impairment.Research questionWhich pulmonary phenotypes are associated with coronary artery disease (CAD) in smokers?Study design and methodsWe 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).ResultsPulmonary 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.InterpretationLung 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.