Journal article
The Association Between Lung Hyperinflation and Coronary Artery Disease in Smokers
Chest, Vol.160(3), pp.858-871
09/2021
DOI: 10.1016/j.chest.2021.04.066
PMCID: PMC8449003
PMID: 33971144
Abstract
Smokers manifest varied phenotypes of pulmonary impairment.
Which pulmonary phenotypes are associated with coronary artery disease (CAD) in smokers?
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
to FVC ratio, < 0.70).
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
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.
Lung hyperinflation is associated strongly with clinical and subclinical CAD in smokers, including those with airflow obstruction. After lung hyperinflation was accounted for, FEV
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.
Details
- Title: Subtitle
- The Association Between Lung Hyperinflation and Coronary Artery Disease in Smokers
- Creators
- Divay Chandra - University of PittsburghAman Gupta - University of PittsburghGregory L Kinney - University of Colorado DenverCarl R Fuhrman - University of PittsburghJoseph K Leader - University of PittsburghAlejandro A Diaz - Brigham and Women's HospitalJessica Bon - University of PittsburghR Graham Barr - Columbia UniversityGeorge Washko - Brigham and Women's HospitalMatthew Budoff - University of California, Los AngelesJohn Hokanson - University of Colorado DenverFrank C Sciurba - University of PittsburghCOPDGene Investigators
- Contributors
- Karin F Hoth (Contributor) - University of Iowa, Psychiatry
- Resource Type
- Journal article
- Publication Details
- Chest, Vol.160(3), pp.858-871
- DOI
- 10.1016/j.chest.2021.04.066
- PMID
- 33971144
- PMCID
- PMC8449003
- NLM abbreviation
- Chest
- ISSN
- 0012-3692
- eISSN
- 1931-3543
- Grant note
- K23 HL126912 / NHLBI NIH HHS HHSN268201100019C / NHLBI NIH HHS R01 HL153400 / NHLBI NIH HHS R01 HL089856 / NHLBI NIH HHS P50 HL084948 / NHLBI NIH HHS R01 HL133137 / NHLBI NIH HHS R01 HL149861 / NHLBI NIH HHS R01 HL089897 / NHLBI NIH HHS RC2 HL101715 / NHLBI NIH HHS
- Language
- English
- Date published
- 09/2021
- Academic Unit
- Psychiatry; Iowa Neuroscience Institute
- Record Identifier
- 9984293655902771
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