Abstract
Airflow obstruction is an independent risk factor for cardiovascular events in the general population. The affected vascular bed and contribution of emphysema to cardiovascular risk are unclear. We examined whether an obstructive pattern of spirometry and quantitatively defined emphysema were associated with subclinical atherosclerosis in the carotid, peripheral and coronary circulations.
The Multi-Ethnic Study of Atherosclerosis recruited participants aged 45–84 yrs without clinical cardiovascular disease. Spirometry, carotid intima-media thickness (IMT), ankle-brachial index (ABI) and coronary artery calcium (CAC) were measured using standard protocols. Percentage of emphysema-like lung was measured in the lung windows of cardiac computed tomography scans among 3,642 participants. Multiple linear regression was used to adjust for cardiac risk factors, including C-reactive protein.
Decrements in forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity ratio were associated with greater internal carotid IMT, particularly among smokers (p=0.03 and p<0.001, respectively) whereas percentage emphysema was associated with reduced ABI regardless of smoking history (p=0.004). CAC was associated with neither lung function (prevalence ratio for the presence of CAC in severe airflow obstruction 0.99, 95% CI 0.91–1.07) nor percentage emphysema.
An obstructive pattern of spirometry and emphysema were associated distinctly and independently with subclinical atherosclerosis in the carotid arteries and peripheral circulation, respectively, and were not independently related to CAC.
- Cardiopulmonary interactions
- cardiovascular epidemiology
- chronic
- emphysema
- obstructive pulmonary disease
Footnotes
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Support Statement
This study was supported by National Institutes of Health grants R01 HL077612, HL093081, HL075476 and N01-HC95159-HC95169. The MESA and MESA Lung Study are supported by the NIH/NHLBI contracts N01-HC-95159–N01-HC-95169 and grants R01 HL-077612, HL-093081 and HL-075476.
Statement of Interest
Statements of interest for R.G. Barr, E.A. Hoffman and S.M. Kawut can be found at www.erj.ersjournals.com/site/misc/statements.xhtml
- Received October 22, 2010.
- Accepted August 22, 2011.
- ©ERS 2012