TOPLINE:

The combination of the cardiovascular risk score (CVRS) and coronary artery calcium score (CACS) improved risk stratification for major adverse cardiovascular events (MACE) in patients with chronic obstructive pulmonary disease (COPD), offering a potentially valuable approach for routine clinical practice.

METHODOLOGY:

• Researchers conducted a multicenter observational cohort study to evaluate whether combining CVRS and CACS improved MACE prediction in patients with COPD.
• They included 549 patients (median age, 63 years; 20% women; 45% active smokers) from four Spanish pulmonary clinics between 2000 and 2011 who underwent clinical evaluation, laboratory testing, and low-dose CT, with a mean follow-up of 98 months.
• Coronary artery calcification, a marker of coronary artery disease, was assessed using the ordinal CACS and categorized as low risk (score, 0-3) or moderate-to-severe risk (score, 4-12).
• The 10-year risk for MACE was calculated for each patient using the Systematic Coronary Risk Evaluation, and patients were categorized as having risk < 10% or ≥ 10% at 10 years.
• Finally, patients were stratified into four 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).

TAKEAWAY:

• During the follow‑up period, 24% of the patients developed MACE and 28% died.
• Patients in group IV were older, had a lower proportion of women, higher proportion of active smokers, worse lung function, and more comorbidities than those in the other groups.
• Compared with patients in group 1, patients in group IV had the highest risk for MACE (hazard ratio [HR], 7.7; P < .01), whereas those in groups II (HR, 2.6; P < .01) and III (HR, 3.1; P < .01) had intermediate risk.
• Although CVRS and CACS were each acceptable in predicting MACE without significant differences, their combination showed superior discriminative performance for MACE compared with either score alone.

IN PRACTICE:

“These scores could be implemented in routine clinical practice (especially now with the implementation of lung cancer screening with chest CT in COPD patients) in order to identify patients who might benefit from invasive testing or more intensive primary preventive measures,” the authors wrote.

SOURCE:

The study was led by Juan P. de-Torres, MD, Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain. It was published online on October 14, 2025, in Chest.

LIMITATIONS:

The cohort primarily consisted of male patients. All sites were in Spain (a region with a low risk for MACE); hence, the findings may not be generalizable to non‑European populations or to populations with a higher risk for MACE. The observational design precluded causal inference. Exacerbation and medication were not systematically recorded, which could have confounded the associations.

DISCLOSURES:

This study did not receive any funding, and no conflicts of interest were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.