Hidden Heart Disease Found in 88% of COPD Patients via CT Scanning

Cardiovascular disease is a leading cause of death in COPD, yet coronary artery disease often goes unrecognized in this population because classic symptoms like chest pain may be masked or misattributed to respiratory causes. This study set out to quantify the true burden of radiologically detectable CAD in COPD and identify which patients are most at risk, while also testing whether existing screening tools could reliably detect it.

Researchers at Imperial College London and Royal Brompton Hospital prospectively enrolled 50 COPD patients and age- and sex-matched controls, performing CT coronary angiography (CTCA) on all participants. Clinical correlates including cardiac symptoms, 6-minute walk distance (6MWD), exacerbation frequency, inflammatory biomarkers, and thoracic CT features were systematically assessed in the COPD cohort. Screening performance of cardiovascular risk scores, biomarkers, and thoracic CT–derived coronary artery calcium (CAC) scores was evaluated using ROC curve analysis.

The headline finding was striking: 88% of COPD patients had any detectable CAD on CTCA. Obstructive CAD (≥50% stenosis) was present in 42%, and severely obstructive CAD (≥70% stenosis) in 28%—representing a 3.1-fold and 10.1-fold higher odds than controls, respectively. Despite this heavy burden, 75% of COPD patients with CAD had no chest pain and no prior ischemic heart disease diagnosis, underscoring how profoundly under-recognized this condition is. CAD severity was associated with reduced 6MWD, pointing to functional impairment rather than classic cardiac symptoms as a potential clinical clue.

Systemic inflammation emerged as a key correlate of CAD extent. Higher fibrinogen, C-reactive protein, leukocyte, and neutrophil counts were all associated with more severe disease. Bronchial wall thickening on CT and sputum bacterial colonization were also linked to greater CAD burden, suggesting shared inflammatory pathways between airway disease and vascular pathology. Notably, exacerbation frequency did not correlate with CAD, implying that acute inflammatory episodes may not be the primary driver of chronic vascular injury in this context.

For screening, the thoracic CT–derived CAC score—obtainable from standard non-ECG-gated chest CT scans already widely used in COPD management—performed exceptionally well, with an AUC of 0.98 for any CAD and 0.89 for obstructive CAD. This substantially outperformed traditional cardiovascular risk scores and biomarkers alone, suggesting that opportunistic CAC scoring from routine thoracic CT could meaningfully improve cardiovascular risk stratification in COPD without requiring additional imaging.