Department of Cardiology, Section 2012, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Eur Heart J Cardiovasc Imaging. 2013 Dec;14(12):1159-66. doi: 10.1093/ehjci/jet057. Epub 2013 May 2.
Cardiovascular conditions are reported to be the most frequent cause of death in patients with chronic obstructive pulmonary disease (COPD). However, it remains unsettled whether severity of COPD per se is associated with coronary artery disease (CAD) independent of traditional cardiovascular risk factors. The aim of this study was to examine the relationship between the presence and severity of COPD and the amount of coronary artery calcium deposit, an indicator of CAD and cardiac risk, in a large population of current and former long-term smokers.
In this cross-sectional study, long-term smokers without clinically manifested CAD were recruited from the Danish Lung Cancer Screening Trial and classified according to lung function by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Coronary artery calcium deposit as a measure of subclinical CAD and cardiac risk was evaluated with multi detector computed tomography and the Agatston coronary artery calcium score (CACS). Participants were categorized into five CACS risk classification groups according to the CACS. The population (n = 1535) consisted of 41% participants without COPD, 28% with mild, and 31% with moderate-to-severe COPD (n = 46 with severe COPD). In addition to age, male gender, hypertension, hypercholesterolaemia, and continued smoking, COPD according to GOLD classification were independent predictors of a higher CACS risk classification group in multivariable analysis [odds ratio (OR): 1.28 (1.01-1.63) and OR: 1.32 (1.05-1.67), for mild and moderate-to-severe COPD, respectively, compared with no COPD].
COPD in long-term smokers is independently correlated with the CACS, while COPD severity per se does not show a dose-response relationship.
据报道，心血管疾病是慢性阻塞性肺疾病（COPD）患者死亡的最常见原因。然而，COPD 的严重程度本身是否与传统心血管危险因素无关的冠状动脉疾病（CAD）相关仍未确定。本研究的目的是在大量当前和既往长期吸烟者中检查 COPD 的存在和严重程度与冠状动脉钙沉积（CAD 和心脏风险的指标）之间的关系。
在这项横断面研究中，从丹麦肺癌筛查试验中招募了没有临床表现为 CAD 的长期吸烟者，并根据全球倡议慢性阻塞性肺疾病（GOLD）标准通过肺功能进行分类。使用多探测器计算机断层扫描和 Agatston 冠状动脉钙评分（CACS）评估冠状动脉钙沉积作为亚临床 CAD 和心脏风险的指标。根据 CACS，参与者被分为五个 CACS 风险分类组。该人群（n=1535）由 41%的无 COPD 参与者、28%的轻度 COPD 参与者和 31%的中重度 COPD 参与者（n=46 例重度 COPD）组成。除了年龄、男性、高血压、高胆固醇血症和持续吸烟外，GOLD 分类中的 COPD 也是多变量分析中更高 CACS 风险分类组的独立预测因素[比值比（OR）：1.28（1.01-1.63）和 OR：1.32（1.05-1.67），分别为轻度和中重度 COPD，与无 COPD 相比]。
长期吸烟者的 COPD 与 CACS 独立相关，而 COPD 的严重程度本身与 CACS 无剂量反应关系。
