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The following is a summary of “COPD Subtypes Are Differentially Associated with Cardiovascular Events and COPD Exacerbations,” published in the July 2024 issue of Pulmonology by Yang et al.

The coronary artery calcium score (CACS) and the ratio of the pulmonary artery to aorta diameters (PAratio), both derived from chest CT scans, are well-established indicators for predicting cardiovascular events and chronic obstructive pulmonary disease (COPD) exacerbations, respectively. However, the interplay between these predictors and their reciprocal impact on outcomes has yet to be fully understood, nor is the prognostic significance of COPD subtypes on these outcomes adequately characterized.

Utilizing data from the COPDGene study, researchers examined the risk of cardiovascular disease (CVD) and COPD exacerbations in patients with COPD, classified according to Global Initiative for Chronic Obstructive Lung Disease spirometric grades 2-4. The study group focused on the CACS and PA ratio measured at study enrollment and employed logistic regression models to analyze these risks. The study population was divided into three COPD subtypes: 1,042 patients with Non-emphysema-predominant COPD (NEPD; low attenuation area at -950 Hounsfield units [LAA-950]<5%), 1,324 with Emphysema-predominant COPD (EPD; LAA-950≥10%), and 465 with Intermediate Emphysema COPD (IE; 5≤LAA-950<10%).

The analysis revealed a significantly higher risk of cardiovascular events among patients with elevated CACS (≥median; Odds Ratio [OR]: 1.61, 95% CI=1.30-2.00) and an increased incidence of COPD exacerbations in those with higher PA ratios (≥1; OR: 1.80, 95% CI=1.46-2.23). Notably, patients with NEPD exhibited a stronger correlation between these CT-derived parameters and clinical outcomes than EPD patients. Specifically, patients with NEPD had higher odds ratios for cardiovascular events associated with elevated CACS (NEPD vs. EPD, OR 2.02 vs. 1.41) and exacerbations related to higher PA ratios (NEPD vs. EPD, OR 2.50 vs. 1.65). The differences in odds ratios between COPD subtypes for CACS and cardiovascular disease were statistically significant.

CACS and PA ratios are significant predictors of cardiovascular events and COPD exacerbations, with their impact varying across different COPD subtypes. The findings underscore the differential prognostic value of these parameters in NEPD versus EPD, suggesting that subtype-specific considerations may enhance risk stratification and management strategies in COPD.

Source: sciencedirect.com/science/article/abs/pii/S0012369224048785