Emphysema Progression and Lung Function Decline Among Angiotensin Converting Enzyme Inhibitors and Angiotensin-Receptor Blockade Users in the COPDGene Cohort

Vickram Tejwani; Ashraf Fawzy; Nirupama Putcha; Peter J Castaldi; Michael H Cho; Katherine A Pratte; Surya P Bhatt; David A Lynch; Stephen M Humphries; Gregory L Kinney; Franco R D'Alessio; Nadia N Hansel; COPDGene Investigators

doi:10.1016/j.chest.2021.05.007

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Emphysema Progression and Lung Function Decline Among Angiotensin Converting Enzyme Inhibitors and Angiotensin-Receptor Blockade Users in the COPDGene Cohort

Journal article

Peer reviewed

Emphysema Progression and Lung Function Decline Among Angiotensin Converting Enzyme Inhibitors and Angiotensin-Receptor Blockade Users in the COPDGene Cohort

Vickram Tejwani, Ashraf Fawzy, Nirupama Putcha, Peter J Castaldi, Michael H Cho, Katherine A Pratte, Surya P Bhatt, David A Lynch, Stephen M Humphries, Gregory L Kinney, …

Chest, Vol.160(4), pp.1245-1254

10/2021

DOI: 10.1016/j.chest.2021.05.007

PMCID: PMC8546238

PMID: 34029566

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https://www.ncbi.nlm.nih.gov/pmc/articles/8546238View

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Abstract

Attenuation of transforming growth factor β by blocking angiotensin II has been shown to reduce emphysema in a murine model. General population studies have demonstrated that the use of angiotensin converting enzyme inhibitors (ACEis) and angiotensin-receptor blockers (ARBs) is associated with reduction of emphysema progression in former smokers and that the use of ACEis is associated with reduction of FEV progression in current smokers. Is use of ACEi and ARB associated with less progression of emphysema and FEV decline among individuals with COPD or baseline emphysema? Former and current smokers from the Genetic Epidemiology of COPD Study who attended baseline and 5-year follow-up visits, did not change smoking status, and underwent chest CT imaging were included. Adjusted linear mixed models were used to evaluate progression of adjusted lung density (ALD), percent emphysema (%total lung volume <-950 Hounsfield units [HU]), 15th percentile of the attenuation histogram (attenuation [in HU] below which 15% of voxels are situated plus 1,000 HU), and lung function decline over 5 years between ACEi and ARB users and nonusers in those with spirometry-confirmed COPD, as well as all participants and those with baseline emphysema. Effect modification by smoking status also was investigated. Over 5 years of follow-up, compared with nonusers, ACEi and ARB users with COPD showed slower ALD progression (adjusted mean difference [aMD], 1.6; 95% CI, 0.34-2.9). Slowed lung function decline was not observed based on phase 1 medication (aMD of FEV % predicted, 0.83; 95% CI, -0.62 to 2.3), but was when analysis was limited to consistent ACEi and ARB users (aMD of FEV % predicted, 1.9; 95% CI, 0.14-3.6). No effect modification by smoking status was found for radiographic outcomes, and the lung function effect was more pronounced in former smokers. Results were similar among participants with baseline emphysema. Among participants with spirometry-confirmed COPD or baseline emphysema, ACEi and ARB use was associated with slower progression of emphysema and lung function decline. ClinicalTrials.gov; No.: NCT00608764; URL: www.clinicaltrials.gov.

Aged

Angiotensin Receptor Antagonists - therapeutic use

Angiotensin-Converting Enzyme Inhibitors - therapeutic use

Cohort Studies

Disease Progression

Female

Forced Expiratory Volume

Humans

Lung Volume Measurements

Male

Middle Aged

Prospective Studies

Protective Factors

Pulmonary Disease, Chronic Obstructive - diagnostic imaging

Pulmonary Disease, Chronic Obstructive - physiopathology

Pulmonary Emphysema - diagnostic imaging

Pulmonary Emphysema - physiopathology

Spirometry

Tomography, X-Ray Computed

Vital Capacity

Walk Test

Details

Title: Subtitle: Emphysema Progression and Lung Function Decline Among Angiotensin Converting Enzyme Inhibitors and Angiotensin-Receptor Blockade Users in the COPDGene Cohort
Creators: Vickram Tejwani - Johns Hopkins University
Ashraf Fawzy - Johns Hopkins University
Nirupama Putcha - Johns Hopkins University
Peter J Castaldi - Brigham and Women's Hospital
Michael H Cho - Brigham and Women's Hospital
Katherine A Pratte - National Jewish Health
Surya P Bhatt - University of Alabama at Birmingham
David A Lynch - National Jewish Health
Stephen M Humphries - National Jewish Health
Gregory L Kinney - Colorado School of Public Health
Franco R D'Alessio - Johns Hopkins University
Nadia N Hansel - Johns Hopkins University
COPDGene Investigators
Contributors: Karin F Hoth (Contributor) - University of Iowa, Psychiatry
Resource Type: Journal article
Publication Details: Chest, Vol.160(4), pp.1245-1254
DOI: 10.1016/j.chest.2021.05.007
PMID: 34029566
PMCID: PMC8546238
NLM abbreviation: Chest
ISSN: 0012-3692
eISSN: 1931-3543
Grant note: R01 HL137927 / NHLBI NIH HHS R01 HL135142 / NHLBI NIH HHS R01 HL147148 / NHLBI NIH HHS R01 HL089856 / NHLBI NIH HHS F32 HL149258 / NHLBI NIH HHS K08 HL141601 / NHLBI NIH HHS R01 HL089897 / NHLBI NIH HHS
Language: English
Date published: 10/2021
Academic Unit: Psychiatry; Iowa Neuroscience Institute
Record Identifier: 9984293658202771

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