Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality

BACKGROUND: Coronary artery calcification is pathognomonic of coronary disease (CAD). Whether CAD in patients with COPD is linked to lung functional capacity and/or clinically relevant outcomes is unknown. The was to assess the association between CAD and disease severity, capacity and outcomes in patients with COPD. METHODS: Coronary artery score (CACS; Agatston score) was measured using chest CT in patients smokers with normal spirometry and non-smokers from the Evaluation of Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) RESULTS: CACS was measured in 942 subjects: 672 with COPD (mean age+/- years; FEV1 49+/-16% predicted), 199 smokers with normal spirometry years; FEV1 110+/-12% predicted) and 71 non-smokers (55+/-9 years; FEV1 predicted). CACS was higher in patients with COPD than smokers or non- (median (IQR), 128 (492) vs 0 (75) vs 0 (3) Agatston units (AU), patients with COPD, CACS correlated with age, pack-years, 6 min walking modified Medical Research Council Dyspnoea score and circulating levels interleukin (IL)-6, IL-8, Clara Cell protein 16, surfactant protein D peripheral blood neutrophil count, but not with emphysema, exacerbation frequency, % predicted FEV1 or decline in FEV1. CACS was higher in COPD who died than in those who survived until 3-year follow-up (CACS AU, p<0.001), and was associated with mortality in a Cox proportional model (p=0.036). CONCLUSIONS: Patients with COPD have more CAD than this is associated with increased dyspnoea, reduced exercise capacity increased mortality. These data indicate that the presence of CAD in with COPD is associated with poor clinical outcomes.