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Pectoralis muscle area and mortality in smokers without airflow obstruction.

ABSTRACT: BACKGROUND:Low muscle mass is associated with increased mortality in the general population but its prognostic value in at-risk smokers, those without expiratory airflow obstruction, is unknown. We aimed to test the hypothesis that reduced muscle mass is associated with increased mortality in at-risk smokers. METHODS:Measures of both pectoralis and paravertebral erector spinae muscle cross-sectional area (PMA and PVMA, respectively) as well as emphysema on chest computed tomography (CT) scans were performed in 3705 current and former at-risk smokers (?10 pack-years) aged 45-80 years enrolled into the COPDGene Study between 2008 and 2013. Vital status was ascertained through death certificate. The association between low muscle mass and mortality was assessed using Cox regression analysis. RESULTS:During a median of 6.5 years of follow-up, 212 (5.7%) at-risk smokers died. At-risk smokers in the lowest (vs. highest) sex-specific quartile of PMA but not PVMA had 84% higher risk of death in adjusted models for demographics, smoking, dyspnea, comorbidities, exercise capacity, lung function, emphysema on CT, and coronary artery calcium content (hazard ratio [HR] 1.85 95% Confidence interval [1.14-3.00] P?=?0.01). Results were consistent when the PMA index (PMA/height2) was used instead of quartiles. The association between PMA and death was modified by smoking status (P?=?0.04). Current smokers had a significantly increased risk of death (lowest vs. highest PMA quartile, HR 2.25 [1.25-4.03] P?=?0.007) while former smokers did not. CONCLUSIONS:Low muscle mass as measured on chest CT scans is associated with increased mortality in current smokers without airflow obstruction. TRIAL REGISTRATION:NCT00608764.

SUBMITTER: Diaz AA

PROVIDER: S-EPMC5894181 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Pectoralis muscle area and mortality in smokers without airflow obstruction.

Diaz Alejandro A AA Martinez Carlos H CH Harmouche Rola R Young Thomas P TP McDonald Merry-Lynn ML Ross James C JC Han Mei Lan ML Bowler Russell R Make Barry B Regan Elizabeth A EA Silverman Edwin K EK Crapo James J Boriek Aladin M AM Kinney Gregory L GL Hokanson John E JE Estepar Raul San Jose RSJ Washko George R GR

Respiratory research 20180410 1

<h4>Background</h4>Low muscle mass is associated with increased mortality in the general population but its prognostic value in at-risk smokers, those without expiratory airflow obstruction, is unknown. We aimed to test the hypothesis that reduced muscle mass is associated with increased mortality in at-risk smokers.<h4>Methods</h4>Measures of both pectoralis and paravertebral erector spinae muscle cross-sectional area (PMA and PVMA, respectively) as well as emphysema on chest computed tomograph ...[more]

PMID: 29636050

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Project description:BACKGROUND:Low lung function is known to predict mortality in the general population, but the prognostic significance of emphysema on computed tomography (CT) in persons without chronic obstructive pulmonary disease (COPD) is uncertain. OBJECTIVE:To determine whether greater emphysema-like lung on CT is associated with all-cause mortality among persons in the general population without airflow obstruction or COPD. DESIGN:Prospective cohort study. SETTING:Population-based, multiethnic sample from 6 U.S. communities. PARTICIPANTS:2965 participants aged 45 to 84 years without airflow obstruction on spirometry. MEASUREMENTS:Emphysema-like lung was defined as the number of lung voxels with attenuation less than -950 Hounsfield units on cardiac CT and was adjusted for the number of total imaged lung voxels. RESULTS:Among 2965 participants, 50.9% of whom had never smoked, there were 186 deaths over a median of 6.2 years. Greater emphysema-like lung was independently associated with increased mortality (adjusted hazard ratio per one-half interquartile range, 1.14 [95% CI, 1.04 to 1.24]; P=0.004) after adjustment for potential confounders, including cardiovascular risk factors and FEV1. Generalized additive models supported a linear association between emphysema-like lung and mortality without evidence for a threshold. The association was of greatest magnitude among smokers, although multiplicative interaction terms did not support effect modification by smoking status. LIMITATIONS:Cardiac CT scans did not include lung apices. The number of deaths was limited among subgroup analyses. CONCLUSION:Emphysema-like lung on CT was associated with all-cause mortality among persons without airflow obstruction or COPD in a general population sample, particularly among smokers. Recognition of the independent prognostic significance of emphysema on CT among patients without COPD on spirometry is warranted. PRIMARY FUNDING SOURCE:National Heart, Lung, and Blood Institute.

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Pectoralis muscle area and mortality in smokers without airflow obstruction.

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Pectoralis muscle area and mortality in smokers without airflow obstruction.

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