The following is a summary of “Idiopathic pulmonary fibrosis is more strongly associated with coronary artery disease than chronic obstructive pulmonary disease,” published in the March 2023 issue of Pulmonology by Bray, et al.
For a study, researchers sought to examine the association between low forced expiratory volume in one second (FEV1) and coronary artery disease (CAD) among adults. Previous research has shown that low FEV1 could be a significant risk factor for CAD. Therefore, they looked at individuals with low FEV1 caused by either spirometric obstruction or ventilatory restriction and assessed whether the association with CAD differed between the two causes.
In the Genetic Epidemiology of COPD (COPDGene) study, lifetime non-smokers with no lung disease and participants with the chronic obstructive pulmonary disease had high-resolution computed tomography (CT) images taken at full inspiration. In addition, we examined CT scans of adults with IPF from a group of patients who visited a quaternary referral clinic. Individuals with IPF were matched 1:1 by age to lifetime non-smokers and 1:1 by FEV1 %predicted to people with COPD. Using the Weston score, coronary arterial calcium (CAC), a proxy for coronary artery disease (CAD), was quantified visually on a CT scan. Weston score 7 was used to signify significant CAC. In the Genetic Epidemiology of COPD (COPDGene) study, lifetime non-smokers with no lung disease and participants with the chronic obstructive pulmonary disease had high-resolution computed tomography (CT) images taken at full inspiration.
In addition, we examined CT scans of adults with IPF from a group of patients who visited a quaternary referral clinic. Individuals with IPF were matched 1:1 by age to lifetime non-smokers and 1:1 by FEV1%predicted to people with COPD. Using the Weston score, coronary arterial calcium (CAC), a proxy for coronary artery disease (CAD), was quantified visually on a CT scan. Weston score 7 was used to signify significant CAC. COPD or IPF was tested for in multivariable regression models after adjusting for age, sex, body mass index, smoking status, hypertension, diabetes mellitus, and hyperlipidemia.
The study had 732 participants, 244 of whom had IPF, 244 who had COPD, and 244 who had never smoked. In IPF, COPD, and non-smokers, respectively, the mean (SD) ages were 72.6 (8.1), 62.6 (7.4), and 67.3 (6.6) years, and the median (IQR) CAC values were 6 (6), 2 (6), and 1 (4), respectively. Compared to non-smokers, people with COPD had higher CACs according to multivariable analysis (adjusted regression coefficient, β = 1.10 ± SE0.51; P = 0.031). In addition, IPF was linked to increased CAC among smokers compared to non-smokers (β = 03.43 ± SE0.41; P < 0.001). Comparing smokers and non-smokers, the adjusted odds ratio for having a substantial CAC was 1.3, 95% CI 0.6 to 2.8; P = 0.53 in COPD and 5.6, 95% CI 2.9 to 10.9; P< 0.001 in IPF. The relationships in sex-separated studies were primarily found in females.
Individuals with IPF demonstrated higher coronary artery calcium than those with COPD after accounting for age and lung function impairment.
Reference: resmedjournal.com/article/S0954-6111(23)00083-5/fulltext