Prospective comparison of non-invasive risk markers of major cardiovascular events in COPD patients

Jorge Zagaceta,Inmaculada Colina,Ciro Casanova,Miguel Divo,Victor M Pinto-Plata,Ana B Alcaide,Gorka Bastarrika,Bartolome R Celli,José M Marin,Juan P De-Torres,Arantza Campo,Javier J Zulueta

doi:10.1186/s12931-017-0658-y

Abstract

BackgroundChronic Obstructive Pulmonary Disease (COPD) is an independent risk factor for cardiovascular (CV) disease, one of the most frequent causes of death in COPD patients. The goal of the present study was to evaluate the prognostic value of non-invasive CV risk markers in COPD patients.MethodsCV risk was prospectively evaluated in 287 COPD patients using non-invasive markers including the Framingham score, the Systematic Coronary Risk Evaluation (SCORE) charts, coronary arterial calcium (CAC), epicardial adipose tissue (EAT), as well as clinical, biochemical and physiological variables. The predictive power of each parameter was explored using CV events as the main outcome.ResultsDuring a median follow up of 65 months (ICR: 36–100), 44 CV events were recorded, 12 acute myocardial infarctions (27.3%), 10 ischemic heart disease/angina (22.7%), 12 peripheral artery disease events requiring surgery (27.3%) and 10 strokes (22.7%). A total of 35 CV deaths occurred during that period. Univariable analysis determined that age, hypertension, CRP, total Cholesterol, LDL-Cholesterol, Framingham score and CAC were independently associated with CV events. Multivariable analysis identified CAC as the best predictor of CV events (HR; 95%CI: 1.32; 1.19–1.46, p < 001).ConclusionsIn COPD patients attending pulmonary clinics, CAC was the best independent non-invasive predictor of CV events. This tool may help evaluate the risk for a CV event in patients with COPD. Larger studies should reproduce and validate these findings.

Highlights

Chronic Obstructive Pulmonary Disease (COPD) is an independent risk factor for cardiovascular (CV) disease, one of the most frequent causes of death in COPD patients
What is the key question? COPD patients are at high risk of major cardiovascular (CV) events
Several non-invasive CV risk markers have been proposed to predict these events in the general population but never been compared in COPD patients

Summary

Introduction

Chronic Obstructive Pulmonary Disease (COPD) is an independent risk factor for cardiovascular (CV) disease, one of the most frequent causes of death in COPD patients. The goal of the present study was to evaluate the prognostic value of non-invasive CV risk markers in COPD patients. Chronic Obstructive Pulmonary Disease (COPD) and cardiovascular disease (CV) are two of the leading causes of death in the world [1]. The recent update of the COPD GOLD guidelines recommend an evaluation for the presence of associated comorbidities [10], they do not specify how to evaluate pre-symptomatic patients through the use of non-invasive tools. The guidelines only state that clinicians should use the same methodology used in patients without the disease, but the potential use of non-invasive tools in the evaluation of future risk for CV events in these patients has not been investigated. A recent systematic review and meta-analysis [11] highlighted the need for the development of strategies to screen for CV risk factors in patients with COPD

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