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Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality
  1. Michelle C Williams1,
  2. John T Murchison2,
  3. Lisa D Edwards3,
  4. Alvar Agustí4,
  5. Per Bakke5,
  6. Peter M A Calverley6,
  7. Bartolome Celli7,
  8. Harvey O Coxson8,
  9. Courtney Crim3,
  10. David A Lomas9,
  11. Bruce E Miller10,
  12. Steve Rennard11,
  13. Edwin K Silverman7,
  14. Ruth Tal-Singer10,
  15. Jørgen Vestbo12,
  16. Emiel Wouters13,
  17. Julie C Yates10,
  18. Edwin J R van Beek14,
  19. David E Newby1,
  20. William MacNee15,
  21. for the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) investigators
  1. 1University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK
  2. 2Royal Infirmary of Edinburgh, Edinburgh, UK
  3. 3GlaxoSmithKline, Research Triangle Park, North Carolina, USA
  4. 4Thorax Institute, Hospital Clinic, Universitat de Barcelona; CIBER Enfermedades Respiratorias (CIBERES), FISIB, Mallorca, Spain
  5. 5University of Bergen, Bergen, Norway
  6. 6Department of Respiratory Medicine, University Hospital Aintree, Liverpool, UK
  7. 7Department of Respiratory Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
  8. 8University of British Columbia, Vancouver, British Columbia, Canada
  9. 9Department of Medicine, University of Cambridge, Cambridge, UK
  10. 10GlaxoSmithKline, King of Prussia, Pennsylvania, USA
  11. 11University of Nebraska Medical Center, Omaha, Nebraska, USA
  12. 12Department of Respiratory Medicine, Odense University & University of Southern Denmark, Denmark/University of Manchester, Academic Health Science Centre, Manchester, UK
  13. 13Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
  14. 14Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
  15. 15Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Michelle C Williams, University/BHF Centre for Cardiovascular Science, Chancellor's Building, SU305, 49 Little France Crescent, Edinburgh EH16SUF, UK; michelle.williams{at}


Background Coronary artery calcification is pathognomonic of coronary artery disease (CAD). Whether CAD in patients with COPD is linked to lung function, functional capacity and/or clinically relevant outcomes is unknown. The objective was to assess the association between CAD and disease severity, functional capacity and outcomes in patients with COPD.

Methods Coronary artery calcium score (CACS; Agatston score) was measured using chest CT in patients with COPD, smokers with normal spirometry and non-smokers from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study.

Results CACS was measured in 942 subjects: 672 with COPD (mean age±SD, 63±7 years; FEV1 49±16% predicted), 199 smokers with normal spirometry (54±9 years; FEV1 110±12% predicted) and 71 non-smokers (55±9 years; FEV1 114±14% predicted). CACS was higher in patients with COPD than smokers or non-smokers (median (IQR), 128 (492) vs 0 (75) vs 0 (3) Agatston units (AU), p<0.001). In patients with COPD, CACS correlated with age, pack-years, 6 min walking distance, modified Medical Research Council Dyspnoea score and circulating levels of interleukin (IL)-6, IL-8, Clara Cell protein 16, surfactant protein D and peripheral blood neutrophil count, but not with emphysema, exacerbation frequency, % predicted FEV1 or decline in FEV1. CACS was higher in patients with COPD who died than in those who survived until 3-year follow-up (CACS 406 vs 103 AU, p<0.001), and was associated with mortality in a Cox proportional hazards model (p=0.036).

Conclusions Patients with COPD have more CAD than controls and this is associated with increased dyspnoea, reduced exercise capacity and increased mortality. These data indicate that the presence of CAD in patients with COPD is associated with poor clinical outcomes.

  • COPD ÀÜ Mechanisms
  • Emphysema
  • Imaging/CT MRI etc

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