Cardiovascular Events in COPD: Complementary Role of Cardiac Risk and Coronary Artery Calcium Scores

Juan P de-Torres; Ciro Casanova; Jorge Zagaceta; José M Marín; Carlos Cabrera; Ana Ezponda; Arantza Campo; Ana Belén Alcaide; Luis Seijo; Gorka Bastarrika; Victor Pinto-Plata; Miguel Divo; Bartolome R Celli

doi:10.1016/j.chest.2025.09.133

Cardiovascular Events in COPD: Complementary Role of Cardiac Risk and Coronary Artery Calcium Scores

Chest. 2025 Oct 14:S0012-3692(25)05526-6. doi: 10.1016/j.chest.2025.09.133. Online ahead of print.

Authors

Affiliations

¹ Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain; Centro de Investigación Biomédica En Red (CIBERES), ISCIII, Madrid, Spain; Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain. Electronic address: jupa65@hotmail.com.
² Department of Pulmonology-Research Unit, Hospital Universitario Nuestra Señora de La Candelaria, CIBERES, ISCIII, Universidad de La Laguna, Santa Cruz de Tenerife, Spain.
³ Clínica Angloamericana, Universidad de Piura, Lima, Peru; Facultad de Medicina Humana, Universidad de Piura, Lima, Peru.
⁴ Department of Pulmonology, Hospital Universitario Miguel Servet, Instituto Aragonés Ciencias Salud and CIBERES, Zaragoza, Spain.
⁵ Centro de Investigación Biomédica En Red (CIBERES), ISCIII, Madrid, Spain; Department of Pulmonology, Hospital Universitario Doctor Negrín, Las Palmas, Spain.
⁶ Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain.
⁷ Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain.
⁸ Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain; Centro de Investigación Biomédica En Red (CIBERES), ISCIII, Madrid, Spain.
⁹ Centro de Investigación Biomédica En Red (CIBERES), ISCIII, Madrid, Spain; Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain.
¹⁰ Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, MA.
¹¹ Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA.
¹² Department of Pulmonology, Brigham and Women's Hospital, Boston, MA.

PMID: 41101639
DOI: 10.1016/j.chest.2025.09.133

Abstract

Background: Patients with COPD are at high risk of major adverse cardiovascular events (MACEs) developing. Existing clinical tools for risk stratification in these patients have underperformed in predicting the outcomes.

Research question: Does a combination of cardiovascular risk score (CVRS) and coronary artery calcium score (CACS) improve risk assessment of MACEs in patients with COPD?

Study design and methods: This was an observational cohort of patients with COPD (n = 529). They underwent a chest CT scan, and clinical, functional, and laboratory data were recorded. The CACS and CVRS (Systematic Coronary Risk Evaluation [SCORE] 2, SCORE2-Older People [OP], SCORE2-Diabetes, and Secondary Manifestations of Arterial Disease [SMART] risk scores) were calculated. Using a threshold of CVRS of ≥ 10% or CACS score of > 3, patients were divided into 4 groups-group I, CVRS < 10% and CACS ≤ 3; group II, CVRS ≥ 10% and CACS ≤ 3; group III, CVRS < 10% and CACS > 3; and group IV, CVRS ≥ 10% and CACS > 3-who were followed up for a median of 98 months. Regression analysis and Kaplan Meier curves were used to compare the risks among groups. Receiver operating characteristic (ROC) curve analysis determined the performance of CACS and CVRS and their combination to predict MACEs.

Results: Most patients were male (80%) with moderate COPD. Over time, 131 patients (24%) experienced a MACE. Compared with group I, the hazard ratios for MACEs were: group IV, 7.6 (95% CI, 4.9-11.9; P < .001); group III, 3.1 (95% CI, 1.8-8.5; P < .001); and group II, 2.6 (95% CI, 1.6-4.2; P < .001). The areas under the ROC curve for predicting MACEs were 0.72 (P < .01) for CACS plus CVRS compared with 0.69 for CVRS and 0.66 for CACS.

Conclusions: The combination of cardiovascular risk and coronary artery calcification scores were shown to provide a complementary role in MACE risk stratification in patients with COPD.

Keywords: COPD; MACE; cardiovascular risk; coronary artery calcium.