Author + information
- Matthew J. Budoff,
- Gregory Kinney,
- John Hokanson,
- Graham Barr,
- Robert Steiner,
- Hrudaya Nath and
- Richard Casaburi
Background: While coronary artery calcium (CAC) has extensive validation for predicting clinical events, most outcome studies of CAC have been performed in asymptomatic populations, and little is known about how CAC predicts mortality in patients with chronic obstructive pulmonary disease (COPD). We evaluated the contribution of CAC using the COPDGene study with over 5 years of follow-up for all-cause mortality, and additionally sought to evaluate whether the association of CAC with mortality varied by sex, race/ethnicity, or COPD GOLD category.
Methods: We utilized COPDGene, a prospective cohort study of 10192 current and former smokers, of which we included 9336 who did not report cardiovascular disease (CVD) at their initial evaluation (baseline). Of those, 8978 had CAC measured from non-contrast CT scans at baseline and 8076 had mortality follow-up. We evaluated the relationship between CAC and all-cause mortality using Cox regression models adjusted for age, gender, cigarette smoking status, high cholesterol, diabetes, lipid-lowering medication, hypertension, COPD stage and BMI.
Results: Overall, 853 participants died in the study population over a median of 80 months. Mortality in the CAC=0 group was 8.26%, 1-100 was 10.47%, 101-400 was 13.55% and >400 was 21.36%. In heavy smokers with no reported CVD at baseline, the highest CAC category (>400) was associated with increased mortality adjusted for known risk factors (HR 1.65: 95% CI 1.32-2.06, p<0.0001), as compared with those with lower CAC scores. There was a strong interaction with advanced COPD GOLD stage, with worsening mortality independently associated with CAC and COPD (HR 2.73, 95% CI 2.27-3.28, p<0.0001). Participants who reported high cholesterol treated with statins had lower mortality (HR 0.67 95% CI 0.54-0.81). Those with high BMI (≥30) had lower mortality (HR 0.96; 95% CI 0.95-0.97).
Conclusions: CAC is associated strongly and in a graded fashion with mortality in a population of smokers, independent of standard risk factors. Worsening COPD is associated with worse mortality and increased BMI is protective in heavy smokers, likely because of the poor prognosis of those with cachexia. Statin use is protective in this population.
Moderated Poster Contributions
Non Invasive Imaging Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-3:55 p.m.
Session Title: Imaging With Cardiac CT: The Case for Calcium
Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography
Presentation Number: 1176M-03
- 2017 American College of Cardiology Foundation