Linking lungs and heart: centrilobular emphysema progression predicts coronary artery calcification progression during 18 years of follow-up.
[BACKGROUND] Low-dose chest computed tomography(LDCT) for lung cancer screening provides an opportunity to evaluate smoking-related comorbidities such as emphysema and coronary artery calcification(CA
- p-value p=0.011
- p-value p=0.003
- 95% CI 1.75-6.63
- 연구 설계 cross-sectional
APA
González J, Yip R, et al. (2026). Linking lungs and heart: centrilobular emphysema progression predicts coronary artery calcification progression during 18 years of follow-up.. Chest. https://doi.org/10.1016/j.chest.2026.03.022
MLA
González J, et al.. "Linking lungs and heart: centrilobular emphysema progression predicts coronary artery calcification progression during 18 years of follow-up.." Chest, 2026.
PMID
41933610
Abstract
[BACKGROUND] Low-dose chest computed tomography(LDCT) for lung cancer screening provides an opportunity to evaluate smoking-related comorbidities such as emphysema and coronary artery calcification(CAC). Although cross-sectional associations exist, the long-term relationship between emphysema subtypes and CAC progression remains undefined.
[RESEARCH QUESTION] Is any emphysema subtype associated with long-term CAC progression?
[STUDY DESIGN AND METHODS] All total 256 participants with ≥15 years of follow-up were used from a prospective cohort of 9,047 asymptomatic, high-risk individuals enrolled in the Mount Sinai Early Lung and Cardiac Action Program(New York, June2000-August2004). Emphysema and its two subtypes-centrilobular(CLE) and paraseptal(PSE)-were visually assessed and graded using an enhanced Fleischner Society classification. CAC was scored using a validated ordinal method. Progression was defined as any increase in total score from baseline to follow-up. Logistic regression was used to identify predictors of CAC progression, including CLE and PSE progression, adjusted for age, smoking status, and pack-years.
[RESULTS] Among 256 participants(50%women, 50%men;median age, 58 years[IQR,52-63]), most (69.1%) were former smokers at enrollment, with a median of 31.1 pack-years[IQR,21-49]. Progression of CAC and emphysema was observed in 182(71.7%) and 145(56.6%) participants, respectively, over a median follow-up of 18.3(IQR:16.7,20.5) years. Participants with CAC progression had significantly higher rates of any emphysema both at baseline(70.9%vs.54.2%; p=0.011) and at follow-up(75.8%vs.56.9%;p=0.003). This group also showed higher median CLE scores at baseline(2.00vs.0.00;p<0.001) and follow-up(5.00 vs. 0.00; p<0.001). In multivariable logistic regression adjusted for age, smoking status, and pack-years, CLE progression was strongly associated with CAC progression(OR 3.32; 95% CI, 1.75-6.63; p<0.001). In contrast, PSE showed no significant association with CAC progression(OR1.17; 95%CI,0.32-5.64;p=0.83).
[INTERPRETATION] In this long-term screening cohort, progression of CLE-but not PSE-was linked to CAC progression, highlighting the value of detailed emphysema assessment in screening programs and supporting CLE as a systemic disorder with prognostic relevance.
[RESEARCH QUESTION] Is any emphysema subtype associated with long-term CAC progression?
[STUDY DESIGN AND METHODS] All total 256 participants with ≥15 years of follow-up were used from a prospective cohort of 9,047 asymptomatic, high-risk individuals enrolled in the Mount Sinai Early Lung and Cardiac Action Program(New York, June2000-August2004). Emphysema and its two subtypes-centrilobular(CLE) and paraseptal(PSE)-were visually assessed and graded using an enhanced Fleischner Society classification. CAC was scored using a validated ordinal method. Progression was defined as any increase in total score from baseline to follow-up. Logistic regression was used to identify predictors of CAC progression, including CLE and PSE progression, adjusted for age, smoking status, and pack-years.
[RESULTS] Among 256 participants(50%women, 50%men;median age, 58 years[IQR,52-63]), most (69.1%) were former smokers at enrollment, with a median of 31.1 pack-years[IQR,21-49]. Progression of CAC and emphysema was observed in 182(71.7%) and 145(56.6%) participants, respectively, over a median follow-up of 18.3(IQR:16.7,20.5) years. Participants with CAC progression had significantly higher rates of any emphysema both at baseline(70.9%vs.54.2%; p=0.011) and at follow-up(75.8%vs.56.9%;p=0.003). This group also showed higher median CLE scores at baseline(2.00vs.0.00;p<0.001) and follow-up(5.00 vs. 0.00; p<0.001). In multivariable logistic regression adjusted for age, smoking status, and pack-years, CLE progression was strongly associated with CAC progression(OR 3.32; 95% CI, 1.75-6.63; p<0.001). In contrast, PSE showed no significant association with CAC progression(OR1.17; 95%CI,0.32-5.64;p=0.83).
[INTERPRETATION] In this long-term screening cohort, progression of CLE-but not PSE-was linked to CAC progression, highlighting the value of detailed emphysema assessment in screening programs and supporting CLE as a systemic disorder with prognostic relevance.