Associations between COPD related manifestations: a cross-sectional study

Respiratory Research

William MacNee⁷  Emiel FM Wouters⁸  Frank WJM Smeenk⁵  Erica PA Rutten²  Cameron OS Price⁴  George S Petrides³  Edwin JR Van Beek⁶  John T Murchison⁴  David A McAllister¹  Elisabeth APM Romme⁸ 

[1] Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK;Program Development Centre, Centre of expertise for chronic organ failure + (CIRO+), Horn, The Netherlands;Department of Radiology, Freeman Hospital, Newcastle, UK;Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK;Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands;Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, Scotland, UK;Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland, UK;Department of Respiratory Medicine, Maastricht University Medical Centre + (MUMC+), P.O. Box 5800, Maastricht 6202 AZ, The Netherlands

关键词: Osteoporosis;    Mortality;    Emphysema;    COPD;    Computed tomography;    Co-morbidity;    Cardiovascular disease;    Bone density;    Arterial stiffness;    Arterial calcification;   

Others  :  792306
DOI  :  10.1186/1465-9921-14-129

 received in 2013-08-21, accepted in 2013-10-22,  发布年份 2013

【 摘 要 】

Background

Cardiovascular disease, osteoporosis and emphysema are associated with COPD. Associations between these factors and whether they predict all-cause mortality in COPD patients are not well understood. Therefore, we examined associations between markers of cardiovascular disease (coronary artery calcification [CAC], thoracic aortic calcification [TAC] and arterial stiffness), bone density (bone attenuation of the thoracic vertebrae), emphysema (PI-950 and 15th percentile) and all-cause mortality in a COPD cohort.

Methods

We assessed CAC, TAC, bone attenuation of the thoracic vertebrae, PI-950 and 15th percentile on low-dose chest computed tomography in COPD subjects. We measured arterial stiffness as carotid-radial pulse wave velocity (PWV), and identified deaths from the national register.

Results

We studied 119 COPD subjects; aged 67.8 ±7.3, 66% were males and mean FEV₁% predicted was 46.0 ±17.5. Subjects were classified into three pre-specificed groups: CAC = 0 (n = 14), 0 < CAC ≤ 400 (n = 41) and CAC > 400 (n = 64). Subjects with higher CAC were more likely to be older (p < 0.001) and male (p = 0.03), and more likely to have higher systolic blood pressure (p = 0.001) and a history of hypertension (p = 0.002) or ischemic heart disease (p = 0.003). Higher CAC was associated with higher PWV (OR 1.62, p = 0.04) and lower bone attenuation (OR 0.32, p = 0.02), but not with 15th percentile, after adjustment for age, sex and pack-years of smoking. In a Cox proportional hazards model, CAC, TAC and 15th percentile predicted all-cause mortality (HR 2.01, 2.09 and 0.66, respectively).

Conclusions

Increased CAC was associated with increased arterial stiffness and lower bone density in a COPD cohort. In addition, CAC, TAC and extent of emphysema predicted all-cause mortality.

Trial registration

Lothian NHS Board, Lothian Research Ethics Committee, LREC/2003/8/28.

【 授权许可】

   
2013 Romme et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Graat-Verboom L, Wouters EF, Smeenk FW, Van den Borne BE, Lunde R, Spruit MA: Current status of research on osteoporosis in COPD: a systematic review. Eur Respir J 2009, 34:209-218.
• [2]Mannino DM, Thorn D, Swensen A, Holguin F: Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 2008, 32:962-969.
• [3]Tanko LB, Christiansen C, Cox DA, Geiger MJ, McNabb MA, Cummings SR: Relationship between osteoporosis and cardiovascular disease in postmenopausal women. J Bone Miner Res 2005, 20:1912-1920.
• [4]Schulz E, Arfai K, Liu X, Sayre J, Gilsanz V: Aortic calcification and the risk of osteoporosis and fractures. J Clin Endocrinol Metab 2004, 89:4246-4253.
• [5]Sabit R, Bolton CE, Edwards PH, Pettit RJ, Evans WD, McEniery CM, Wilkinson IB, Cockcroft JR, Shale DJ: Arterial stiffness and osteoporosis in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007, 175:1259-1265.
• [6]McAllister DA, Maclay JD, Mills NL, Mair G, Miller J, Anderson D, Newby DE, Murchison JT, MacNee W: Arterial stiffness is independently associated with emphysema severity in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007, 176:1208-1214.
• [7]Bon J, Fuhrman CR, Weissfeld JL, Duncan SR, Branch RA, Chang CC, Zhang Y, Leader JK, Gur D, Greenspan SL, Sciurba FC: Radiographic emphysema predicts low bone mineral density in a tobacco-exposed cohort. Am J Respir Crit Care Med 2011, 183:885-890.
• [8]Divo M, Cote C, De Torres JP, Casanova C, Marin JM, Pinto-Plata V, Zulueta J, Cabrera C, Zagaceta J, Hunninghake G, Celli B: Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2012, 186:155-161.
• [9]Budoff MJ, Nasir K, Kinney GL, Hokanson JE, Barr RG, Steiner R, Nath H, Lopez-Garcia C, Black-Shinn J, Casaburi R: Coronary artery and thoracic calcium on noncontrast thoracic CT scans: comparison of ungated and gated examinations in patients from the COPD gene cohort. J Cardiovasc Comput Tomogr 2011, 5:113-118.
• [10]Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R: Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990, 15:827-832.
• [11]Romme EA, Murchison JT, Phang KF, Jansen FH, Rutten EP, Wouters EF, Smeenk FW, Van Beek EJ, MacNee W: Bone attenuation on routine chest CT correlates with bone mineral density on DXA in patients with COPD. J Bone Miner Res 2012, 27:2338-2343.
• [12]Van Popele NM, Mattace-Raso FU, Vliegenthart R, Grobbee DE, Asmar R, Van der Kuip DA, Hofman A, De Feijter PJ, Oudkerk M, Witteman JC: Aortic stiffness is associated with atherosclerosis of the coronary arteries in older adults: the rotterdam study. J Hypertens 2006, 24:2371-2376.
• [13]Farrar DJ, Bond MG, Riley WA, Sawyer JK: Anatomic correlates of aortic pulse wave velocity and carotid artery elasticity during atherosclerosis progression and regression in monkeys. Circulation 1991, 83:1754-1763.
• [14]Demer LL: Effect of calcification on in vivo mechanical response of rabbit arteries to balloon dilation. Circulation 1991, 83:2083-2093.
• [15]Barr RG, Ahmed FS, Carr JJ, Hoffman EA, Jiang R, Kawut SM, Watson K: Subclinical atherosclerosis, airflow obstruction and emphysema: the MESA lung study. Eur Respir J 2012, 39:846-854.
• [16]Sverzellati N, Cademartiri F, Bravi F, Martini C, Gira FA, Maffei E, Marchiano A, La VC, De FM, Kuhnigk JM, Rossi C, Pastorino U: Relationship and prognostic value of modified coronary artery calcium score, FEV1, and emphysema in lung cancer screening population: the MILD trial. Radiology 2012, 262:460-467.
• [17]McAllister DA, MacNee W, Duprez D, Hoffman EA, Vogel-Claussen J, Criqui MH, Budoff M, Jiang R, Bluemke DA, Barr RG: Pulmonary function is associated with distal aortic calcium, not proximal aortic distensibility, MESA lung study. COPD 2011, 8:71-78.
• [18]MacNee W, Maclay J, McAllister D: Cardiovascular injury and repair in chronic obstructive pulmonary disease. Proc Am Thorac Soc 2008, 5:824-833.
• [19]Bon J: Does radiographic emphysema correlate with low bone mineral density? Curr Opin Pulm Med 2012, 18:125-130.
• [20]Ohara T, Hirai T, Muro S, Haruna A, Terada K, Kinose D, Marumo S, Ogawa E, Hoshino Y, Niimi A, Chin K, Mishima M: Relationship between pulmonary emphysema and osteoporosis assessed by CT in patients with COPD. Chest 2008, 134:1244-1249.
• [21]Jacobs PC, Prokop M, Van der Graaf Y, Gondrie MJ, Janssen KJ, De Koning HJ, Isgum I, Van Klaveren RJ, Oudkerk M, Van GB, Mali WP: Comparing coronary artery calcium and thoracic aorta calcium for prediction of all-cause mortality and cardiovascular events on low-dose non-gated computed tomography in a high-risk population of heavy smokers. Atherosclerosis 2010, 209:455-462.
• [22]Shaw LJ, Raggi P, Callister TQ, Berman DS: Prognostic value of coronary artery calcium screening in asymptomatic smokers and non-smokers. Eur Heart J 2006, 27:968-975.
• [23]Mohlenkamp S, Lehmann N, Moebus S, Schmermund A, Dragano N, Stang A, Siegrist J, Mann K, Jockel KH, Erbel R: Quantification of coronary atherosclerosis and inflammation to predict coronary events and all-cause mortality. J Am Coll Cardiol 2011, 57:1455-1464.
• [24]Karras A, Haymann JP, Bozec E, Metzger M, Jacquot C, Maruani G, Houillier P, Froissart M, Stengel B, Guardiola P, Laurent S, Boutouyrie P, Briet M: Large artery stiffening and remodeling Are independently associated with All-cause mortality and cardiovascular events in chronic kidney disease. Hypertension 2012, 60:1451-1457.
• [25]Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM: Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999, 99:2434-2439.
• [26]Laurent S, Cockcroft J, Van BL, Boutouyrie P, Giannattasio C, Hayoz D, Pannier B, Vlachopoulos C, Wilkinson I, Struijker-Boudier H: Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006, 27:2588-2605.
• [27]Pannier B, Guerin AP, Marchais SJ, Safar ME, London GM: Stiffness of capacitive and conduit arteries: prognostic significance for end-stage renal disease patients. Hypertension 2005, 45:592-596.
• [28]Celli BR, Locantore N, Yates J, Tal-Singer R, Miller BE, Bakke P, Calverley P, Coxson H, Crim C, Edwards LD, Lomas DA, Duvoix A, MacNee W, Rennard S, Silverman E, Vestbo J, Wouters E, Agusti A: Inflammatory biomarkers improve clinical prediction of mortality in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2012, 185:1065-1072.
• [29]Van der Klift M, Pols HA, Geleijnse JM, Van der Kuip DA, Hofman A, De Laet CE: Bone mineral density and mortality in elderly men and women: the Rotterdam study. Bone 2002, 30:643-648.
• [30]Szulc P, Maurice C, Marchand F, Delmas PD: Increased bone resorption is associated with higher mortality in community-dwelling men > or = 50 years of age: the MINOS study. J Bone Miner Res 2009, 24:1116-1124.