R. Chad Wade, MD1,2,3,4 Sharon X. Ling, PhD†5 Erika S. Helgeson, PhD5 Helen Voelker, MS5 Wassim W. Labaki, MD, MS6 Daniel Meza, MD7 Oisin O’Corragain, MD8 Jennifer Y. So, MD9 Gerard J. Criner, MD8 MeiLan K. Han, MD, MS6 Ravi Kalhan, MD7 Robert M. Reed, MD9 Mark T. Dransfield, MD1,2,3,4 J. Michael Wells, MD, MSPH1,2,3,4
Author Affiliations
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Lung Health Center, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Acute Care Service, Birmingham VA Medical Center, Birmingham, Alabama, United States
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, United States
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pennsylvania, United States
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
†
Deceased
Address correspondence to:
R. Chad Wade, MD
Division of Pulmonary, Allergy, and Critical Care Medicine
University of Alabama at Birmingham
Phone: (205) 934-5555
Email: rcwade@uabmc.edu
Abstract
Introduction: In 2019, the Beta-Blockers for the Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease study (BLOCK-COPD) evaluated the effect of metoprolol on exacerbation risk and mortality in a COPD population without indications for beta-blocker use. We hypothesized that an imaging metric of coronary artery disease (CAD), the coronary artery calcium (CAC) score, would predict exacerbation risk and identify a differential response to metoprolol treatment.
Methods: The study population includes participants in the BLOCK-COPD study from multiple study sites. Participants underwent clinically indicated thoracic computed tomography (CT) scans ± 12 months from enrollment. The Weston scoring system quantified CAC. Adjusted Cox proportional hazards models evaluated for associations between CAC and time to exacerbation.
Results: Data is included for 109 participants. The mean CAC score was 5.1±3.7, and 92 participants (84%) had CAC scores greater than 0. Over a median (interquartile range) follow-up time of 350 (280 to 352) days, there were 61 mild exacerbations and 19 severe/very severe exacerbations. No associations were found between exacerbations of any severity and CAC>0 or total CAC. Associations were observed between total CAC and CAC>0 in the left circumflex (LCx) and time to exacerbation of any severity (adjusted hazard ratio [aHR]=1.39, confidence interval [CI]: 1.08–1.79, p=0.01) and (aHR=1.96, 95% CI: 1.04–3.70, p= 0.04), respectively.
Conclusion: CAD is a prevalent comorbidity in COPD accounting for significant mortality. Our study confirms the high prevalence of CAD using the CAC score; however, we did not discover an association between CAC and exacerbation risk. We did find novel associations between CAC in the LCx and exacerbation risk which warrant further investigation in larger cohorts.
Citation
Citation: Wade RC, Ling SX, Helgeson ES, et al. Associations between coronary artery calcium score and exacerbation risk in BLOCK-COPD. J COPD F. 2024; 11(1): 101-105. doi: http://doi.org/10.15326/jcopdf.11.1.2023.0423