Idiopathic pulmonary fibrosis is more strongly associated with coronary artery disease than chronic obstructive pulmonary disease.
Idiopathic pulmonary fibrosis is more strongly associated with coronary artery disease than chronic obstructive pulmonary disease.
复制标题
与慢性阻塞性肺疾病相比，特发性肺纤维化与冠状动脉疾病的相关性更强。
DOI：
10.1016/j.rmed.2023.107195
复制
发表时间：
2023
影响因子：
4.3
通讯作者：
Bhatt,SuryaP
中科院分区：
文献类型：
--
作者：
Bray,Kevin;Bodduluri,Sandeep;Kim,Young-Il;Sthanam,Vivek;Nath,Hrudaya;Bhatt,SuryaP
简介之前的研究表明，一秒用力呼气量 (FEV1) 过低导致冠状动脉疾病 (CAD) 的人群风险很大。 FEV1 可能较低，原因可能是气流阻塞或通气受限。目前尚不清楚肺活量阻塞或限制引起的低 FEV1 是否与 CAD 存在不同的相关性。方法我们分析了无肺部疾病的终生不吸烟成年人（对照）和参加 COPD 遗传流行病学 (COPDGene) 研究的患有慢性阻塞性肺病的成年人在完全吸气时获得的高分辨率计算机断层扫描 (CT) 扫描。我们还分析了来自四级转诊诊所的一组患者的特发性肺纤维化 (IPF) 成人的 CT 扫描结果。 IPF 参与者按 FEV1% 预测与患有 COPD 的成人进行 1:1 匹配，按年龄与终生不吸烟者进行 1:1 匹配。冠状动脉钙 (CAC) 是 CAD 的替代指标，通过使用 Weston 评分在 CT 上进行视觉量化来测量。显着 CAC 定义为 Weston 评分≥7。使用多变量回归模型来测试 COPD 或 IPF 与 CAC 的关联，并调整年龄、性别、体重指数、吸烟状况、高血压、糖尿病和高脂血症。结果我们纳入了 732 名受试者。 244 名 IPF 患者、244 名 COPD 患者以及 244 名终生不吸烟者。 IPF、COPD 和非吸烟者的平均 (SD) 年龄分别为 72.6 (8.1)、62.6 (7.4) 和 67.3 (6.6) 岁，中位 (IQR) CAC 分别为 6 (6)、2 (6) 和 1 (4)。在多变量分析中，与非吸烟者相比，COPD 的存在与较高的 CAC 相关（调整后的回归系数，β = 1.10 ± SE0.51；P = 0.031）。与非吸烟者相比，IPF 的存在也与较高的 CAC 相关（β = 03.43 ± SE0.41；P < 0.001）。与非吸烟者相比，COPD 患者出现显着 CAC 的调整后比值比为 1.3，95% CI 0.6 至 2.8；P= 0.53；IPF 患者为 5.6，95% CI 2.9 至 10.9；P < 0.001。在性别分层分析中，这些关联主要在女性中出现。 结论 考虑到年龄和肺功能损伤后，患有 IPF 的成人比患有 COPD 的成人表现出更高的冠状动脉钙。
IntroductionPrevious studies have shown that the population attributable risk of low forced expiratory volume in one second (FEV1) for coronary artery disease (CAD) is substantial. FEV1can be low either because of airflow obstruction or ventilatory restriction. It is not known if low FEV1arising from spirometric obstruction or restriction are differently associated with CAD.MethodsWe analyzed high resolution computed tomography (CT) scans acquired at full inspiration in lifetime non-smoker adults with no lung disease (controls) and those with chronic obstructive pulmonary disease enrolled in the Genetic Epidemiology of COPD (COPDGene) study. We also analyzed CT scans of adults with idiopathic pulmonary fibrosis (IPF) from a cohort of patients attending a quaternary referral clinic. Participants with IPF were matched 1:1 by FEV1%predicted to adults with COPD and 1:1 by age to lifetime non-smokers.Coronary artery calcium (CAC), a surrogate for CAD, was measured by visual quantification on CT using the Weston score. Significant CAC was defined as Weston score ≥7. Multivariable regression models were used to test the association of the presence of COPD or IPF with CAC, with adjustment for age, sex, body-mass-index, smoking status, hypertension, diabetes mellitus, and hyperlipidemia.ResultsWe included 732 subjects in the study; 244 with IPF, 244 with COPD, and 244 lifetime non-smokers. The mean (SD) age was 72.6 (8.1), 62.6 (7.4), and 67.3 (6.6) years, and median (IQR) CAC was 6 (6), 2 (6), and 1 (4), in IPF, COPD, and non-smokers, respectively. On multivariable analyses, the presence of COPD was associated with higher CAC compared to non-smokers (adjusted regression coefficient, β = 1.10 ± SE0.51;P= 0.031). The presence of IPF was also associated with higher CAC compared to non-smokers (β = 03.43 ± SE0.41;P< 0.001). The adjusted odds ratio for having significant 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, compared to non-smokers. In sex stratified analyses, these associations were mainly noted in women.ConclusionAdults with IPF displayed higher coronary artery calcium than those with COPD after accounting for age and lung function impairment.