Ectopic adiposity and cardiometabolic health in COPD

Figures & data

Table 1 Baseline characteristics by groupa

	Control subjects (n=119)	GOLD 1 COPD (n=70)	GOLD 2 COPD (n=74)	P-value Overallb	P-value GOLD 1 vs controls	P-value GOLD 2 vs controls	P-value GOLD 1 vs GOLD 2
Age (years)	64.5±9.0	66.4±9.9	63.9±8.8	0.221	0.361	0.895	0.234
Male, n (%)	73 (61)	54 (77)	39 (53)	0.007	0.023	0.238	0.002
BMI (kg/m^2)	27.2±4.9	26.3±3.6	27.4±5.6	0.322	0.484	0.908	0.331
Waist-to-hip ratio	0.93±0.09	0.94±0.07	0.94±0.10	0.403	0.464	0.573	0.987
Current smokers, n (%)	12 (10)	15 (21)	24 (32)	0.003	0.104	0.0004	0.247
Former smokers, n (%)	70 (59)	37 (53)	37 (50)
Never smokers, n (%)	37 (31)	18 (26)	13 (18)
Pack/year	16±18	21±24	37±29	<0.001	<0.334	<0.001	<0.001
Pulmonary function
Post-BD FEV1 (L)	2.95±0.79	2.80±0.74	1.79±0.63	<0.001	0.409	<0.001	<0.001
Post-BD, FEV1, % predicted	102±13	95±12	64±13	<0.001	<0.001	<0.001	<0.001
Post-BD FVC (L)	3.83±1.04	4.37±1.10	3.17±0.96	<0.003	<0.001	<0.001	<0.001
Post-BD FVC, % predicted	122±17	136±22	104±18	<0.001	<0.001	<0.001	<0.001
Post-BD FEV1/FVC, %	77±4	64±5	56±9	<0.001	<0.001	<0.001	<0.001
Medication at baseline
Short-acting BD, n (%)	2 (1.7)	5 (7.1)	19 (26.7)	<0.001	0.060	<0.001	0.002
Long-acting BD, n (%)	1 (0.8)	0 (0)	1 (1.4)	0.5075	0.335	0.737	0.247
Inhaled CS, n (%)	3 (0.3)	7 (10.0)	26 (35.1)	<0.001	0.030	<0.001	<0.001
ACE/ARB, n (%)	22 (18.4)	14 (20.0)	23 (31.1)	0.117	0.799	0.046	0.127
β-Blockers, n (%)	9 (7.6)	4 (5.7)	10 (13.5)	0.228	0.623	0.183	0.109
Statins, n (%)	28 (23.5)	18 (25.7)	20 (27.0)	0.854	0.736	0.586	0.858
Other hypolipidemic drugs, n (%)	4 (3.3)	1 (1.4)	2 (2.7)	0.704	0.403	0.796	0.589
Oral hypoglycemic agents, n (%)	9 (7.6)	4 (5.7)	6 (8.1)	0.836	0.623	0.891	0.571

Notes:

a Values are mean±SD.

b P-test for the global effect of group GOLD with post hoc comparisons done with protected LSD.

Abbreviations: GOLD, Global initiative for chronic Obstructive Lung Disease; ACE, angiotensin-converting enzyme inhibitors; ARB, angiotensin II receptor blockers; BD, bronchodilator; BMI, body mass index; CS, corticosteroids; LSD, least significant difference method.

Table 2 Blood glucose, lipid, adipokine, and Hs-CRP profilesa

	Control subjects (n=119)	GOLD 1 COPD (n=70)	GOLD 2 COPD (n=74)	P-value Overallb	P-value GOLD 1 vs controls	P-value GOLD 2 vs controls	P-value GOLD 1 vs GOLD 2
Glucose (mmol/L)	5.8±1.3	5.7±1.3	6.0±1.4	0.268	0.483	0.285	0.106
Insulin (pmol/L)	130±168	117±170	120±176	0.859	0.616	0.700	0.931
HBA1C (%)	5.7±0.6	5.6±0.6	5.8±0.6	0.120	0.327	0.170	0.040
Total cholesterol (mmol/L)	4.89±1.13	5.11±1.14	4.92±1.19	0.400	0.184	0.831	0.343
LDL-cholesterol (mmol/L)	2.77±1.00	2.96±1.01	2.74±1.05	0.375	0.218	0.845	0.218
HDL-cholesterol (mmol/L)	1.47±0.45	1.51±0.45	1.54±0.47	0.624	0.535	0.360	0.777
Triglycerides (mmol/L)	1.43±0.73	1.42±0.74	1.44±0.77	0.994	0.986	0.926	0.922
Apolipoprotein B (g/L)	0.92±0.25	0.92±0.26	0.92±0.27	0.977	0.836	0.987	0.870
Apolipoprotein A1 (g/L)	1.56±0.28	1.59±0.28	1.63±0.29	0.224	0.473	0.09	0.356
GGT (U/L)	29.8±26.3	23.2±26.7	29.3±27.7	0.231	0.101	0.910	0.191
ALT (U/L)	20.9±10.2	18.2±10.1	22.2±10.7	0.065	0.076	0.413	0.025
AST (U/L)	24.7±7.3	23.2±7.34	25.5±7.7	0.218	0.207	0.487	0.090
Leptin (ng/mL)	12.1±11.4	9.0±11.6	14.3±12.0	0.033	0.078	0.229	0.010
Adiponectin (ng/mL)	7.7±4.8	9.1±4.9	9.0±5.0	0.098	0.068	0.087	0.966
Leptin/adiponectin	2.28±2.89	1.32±2.91	2.33±3.01	0.057	0.027	0.905	0.046
Resistin (ng/mL)	6.98±3.15	6.91±3.19	7.00±3.30	0.984	0.883	0.970	0.873
Ghrelin (pg/mL)	551±651	656±663	670±685	0.407	0.294	0.254	0.906
Hs-CRP (mg/L)	1.82±3.11	1.91±3.15	3.38±3.26	0.004	0.845	0.002	0.007

Notes:

a Values are mean±SD corrected for age, sex, and tobacco exposure (pack-years).

b P-test for the global effect of group GOLD with post hoc comparisons done with protected LSD.

Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, gamma glutamyl-transferase; GOLD, Global initiative for chronic Obstructive Lung Disease; HBA1C, glycosylated hemoglobin; Hs-CRP, high-sensitivity C-reactive protein.

Figure 1 Proportion of subjects in each group with a diagnosis of hypertension (A), diabetes, (B), coronary artery disease (C), and peripheral artery disease (D).

Abbreviations: GOLD, Global initiative for chronic Obstructive Lung Disease; NS, not significant.

Table 3 Coronary artery calcification and liver densitya

	Control subjects (n=119)	GOLD 1 COPD (n=70)	GOLD 2 COPD (n=74)	P-value Overallb	P-value GOLD 1 vs controls	P-value GOLD 2 vs controls	P-value GOLD 1 vs GOLD 2
Coronary artery calcification
Agatston total calcium score	352±512	270±520	342±550	0.557	0.294	0.911	0.429
Agatston total calcium volume	287±411	223±417	283±442	0.607	0.337	0.946	0.451
Fat liver infiltration
Liver density (HU)	58.4±10.0	59.1±10.0	58.2±10.4	0.866	0.655	0.905	0.622

Notes:

a Values are mean±SD corrected for age, sex, and tobacco exposure (pack-years).

b P-test for the global effect of group GOLD with post hoc comparisons done with protected LSD.

Abbreviations: GOLD, Global initiative for chronic Obstructive Lung Disease; HU, Hounsfield units; LSD, least significant difference method.

Figure 2 Group mean values±SD for body mass index (A), waist-to-hip ratio (B), muscle tissue cross-sectional area (muscle tissue CSA; C), muscle tissue attenuation (D), visceral adipose tissue CSA (E), visceral adipose tissue attenuation (F), subcutaneous adipose tissue CSA (G), and total adipose tissue CSA (H), in control subjects (open bars) and subjects with Global initiative for chronic Obstructive Lung Disease (GOLD) 1 (gray bars) and 2+ (black bars) COPD.

Abbreviations: NS, not significant; CSA, cross-sectional tissue area; HU, Hounsfield units.

Table 4 Predictors of cardiovascular comorbidities in multiple regression analyses

	Estimate	SE	Odds ratio	95% CI	P-value	C-statistic
Hypertension						0.83
VAT CSA (cm^2)	0.011	0.002	1.011	1.007–1.015	<0.001
Age (years)	0.093	0.021	1.097	1.053–1.142	<0.001
Post BD, FEV1, % predicted	−0.020	0.008	0.981	0.965–0.997	0.0177
Diabetes						0.83
VAT CSA (cm^2)	0.010	0.002	1.010	1.006–1.014	<0.001
SCAT attenuation (HU)	0.067	0.027	1.070	1.016–1.127	0.002
Age (years)	0.059	0.026	1.060	1.009–1.115	0.0216
Coronary artery disease						0.86
MT attenuation (HU)	−0.276	0.069	0.759	0.662–0.869	<0.001
Sex, male	3.042	1.111	20.9	2.4–185	0.0062

Abbreviations: BD, bronchodilator; C-statistic, area under the ROC curve; ROC, receiver operating characteristic; VAT, visceral adipose tissue; FEV₁, forced expiratory volume in 1 s; CSA, cross-sectional tissue area; HU, Hounsfield units; MT, muscle tissue; SCAT, subcutaneous adipose tissue.