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The Association Between Lung Hyperinflation and Coronary Artery Disease in Smokers.

Publication ,  Journal Article
Chandra, D; Gupta, A; Kinney, GL; Fuhrman, CR; Leader, JK; Diaz, AA; Bon, J; Barr, RG; Washko, G; Budoff, M; Hokanson, J; Sciurba, FC ...
Published in: Chest
September 2021

BACKGROUND: Smokers manifest varied phenotypes of pulmonary impairment. RESEARCH QUESTION: Which pulmonary phenotypes are associated with coronary artery disease (CAD) in smokers? STUDY DESIGN AND METHODS: 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 (FEV1 to FVC ratio, < 0.70). RESULTS: 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). FEV1 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. INTERPRETATION: Lung hyperinflation is associated strongly with clinical and subclinical CAD in smokers, including those with airflow obstruction. After lung hyperinflation was accounted for, FEV1 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.

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Published In

Chest

DOI

EISSN

1931-3543

Publication Date

September 2021

Volume

160

Issue

3

Start / End Page

858 / 871

Location

United States

Related Subject Headings

  • United States
  • Tomography, X-Ray Computed
  • Smoking
  • Risk Factors
  • Respiratory System
  • Respiratory Function Tests
  • Pulmonary Emphysema
  • Plethysmography
  • Organ Size
  • Middle Aged
 

Citation

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Chandra, D., Gupta, A., Kinney, G. L., Fuhrman, C. R., Leader, J. K., Diaz, A. A., … COPDGene Investigators, . (2021). The Association Between Lung Hyperinflation and Coronary Artery Disease in Smokers. Chest, 160(3), 858–871. https://doi.org/10.1016/j.chest.2021.04.066
Chandra, Divay, Aman Gupta, Gregory L. Kinney, Carl R. Fuhrman, Joseph K. Leader, Alejandro A. Diaz, Jessica Bon, et al. “The Association Between Lung Hyperinflation and Coronary Artery Disease in Smokers.Chest 160, no. 3 (September 2021): 858–71. https://doi.org/10.1016/j.chest.2021.04.066.
Chandra D, Gupta A, Kinney GL, Fuhrman CR, Leader JK, Diaz AA, et al. The Association Between Lung Hyperinflation and Coronary Artery Disease in Smokers. Chest. 2021 Sep;160(3):858–71.
Chandra, Divay, et al. “The Association Between Lung Hyperinflation and Coronary Artery Disease in Smokers.Chest, vol. 160, no. 3, Sept. 2021, pp. 858–71. Pubmed, doi:10.1016/j.chest.2021.04.066.
Chandra D, Gupta A, Kinney GL, Fuhrman CR, Leader JK, Diaz AA, Bon J, Barr RG, Washko G, Budoff M, Hokanson J, Sciurba FC, COPDGene Investigators. The Association Between Lung Hyperinflation and Coronary Artery Disease in Smokers. Chest. 2021 Sep;160(3):858–871.

Published In

Chest

DOI

EISSN

1931-3543

Publication Date

September 2021

Volume

160

Issue

3

Start / End Page

858 / 871

Location

United States

Related Subject Headings

  • United States
  • Tomography, X-Ray Computed
  • Smoking
  • Risk Factors
  • Respiratory System
  • Respiratory Function Tests
  • Pulmonary Emphysema
  • Plethysmography
  • Organ Size
  • Middle Aged