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The Association Between Lung Hyperinflation and Coronary Artery Disease in Smokers
- Source :
- Chest
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
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 (FEV(1) 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). FEV(1) 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, FEV(1) 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.
- Subjects :
- Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Coronary Artery Disease
Critical Care and Intensive Care Medicine
COPD: Original Research
Coronary artery disease
03 medical and health sciences
FEV1/FVC ratio
0302 clinical medicine
Functional residual capacity
Risk Factors
Internal medicine
medicine
Humans
Lung volumes
030212 general & internal medicine
Myocardial infarction
Lung
Subclinical infection
COPD
business.industry
Smoking
Organ Size
Middle Aged
respiratory system
medicine.disease
Coronary Vessels
United States
Respiratory Function Tests
respiratory tract diseases
Airway Obstruction
Plethysmography
Biological Variation, Population
Pulmonary Emphysema
030228 respiratory system
Asymptomatic Diseases
Cohort
Cardiology
Airway Remodeling
Female
Tomography, X-Ray Computed
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 00123692
- Volume :
- 160
- Database :
- OpenAIRE
- Journal :
- Chest
- Accession number :
- edsair.doi.dedup.....f1ace18852a510bd740a2be22038902b