Skip to main content
NHLBIHIN
HIN Home Link to the HIN Home Page

Can mild COPD limit heart function?

One in five Americans over the age of 45 has chronic obstructive pulmonary disease (COPD). COPD includes damaged lung tissue (emphysema), as well as inflamed airways and increased mucus production (chronic obstructive bronchitis). These alterations impair the flow of air in the lungs and make breathing more difficult. It’s long been known that severe COPD can decrease the ability of the heart to pump effectively. A new study now shows that even mild COPD, in which the disease has no or only mild symptoms, can diminish heart function.

What was the study?

The study, "Percent emphysema, airflow obstruction, and impaired left ventricular filling," was funded by the National Heart, Lung, and Blood Institute (NHLBI) and published in The New England Journal of Medicine, January 21, 2010.

  • Participants were part of the MESA Lung Study, an extension of the Multi-Ethnic Study of Atherosclerosis (MESA). This large, NHLBI-supported multicenter, prospective cohort study is focused on finding early signs of heart, lung, and blood diseases before symptoms appear.
  • The participants were 2,816 generally healthy individuals' ages 45 to 84 years (mean of 61 years); were 49% male; and were 36% white, 25% African American, 22% Hispanic, and 18% Asian.
  • Heart structure and function were measured by cardiac magnetic resonance imaging (MRI).
The extent of emphysema was measured quantitatively from computed tomography (CT) scans and airflow obstruction was measured by spirometry.

What did the study find?

  • The percent emphysema and the severity of airflow obstruction were positively and linearly associated with impaired left ventricular filling, reduced stroke volume, and lower cardiac output. Even mild COPD was associated with decreased heart function.
  • The associations between percentage emphysema and heart function were present among participants with mild COPD who had never smoked.
  • The magnitudes of the associations were greater among current smokers than among former smokers, and greater in former smokers than in participants who had never smoked. Of the participants, 13% were current smokers, 38% were former smokers, and 49% had never smoked.
  • The percent emphysema and the severity of airflow obstruction were not associated with left ventricular ejection fraction, which reflects a different kind of heart problem.
Because the MESA study population is ethnically mixed and covers a broad age range of apparently healthy people, the results of this study may be widely applicable to the general U.S. population.

What are the take-home messages?

  • COPD diminishes the heart's ability to pump effectively even when the disease has no or only mild symptoms.
  • COPD is the 4th leading cause of death in the United States. The number of people who have it is increasing—more than 12 million are currently diagnosed, and it is estimated that another 12 million may have COPD but do not realize it. Of the leading killers, COPD is the only disease with mortality rates that are on the rise, rather than on the decline.
  • Health care providers are encouraged to learn more about the risk factors, diagnosis, and treatment of COPD. Proactive treatment of COPD can improve and extend lives and may impact heart function as well as lung health. COPD patients will become a greater proportion of healthcare providers' caseloads, particularly in the primary care setting. Family physicians have a primary role in the diagnosis and management of COPD.
  • Risk factors other than cigarette smoking history are important: 10 to 20 percent of COPD cases may be due to environmental and occupational exposures. As many as 1 out of 6 people with COPD has never smoked.

Where can I learn more?

  • Barr, RG, et al. Percent emphysema, airflow obstruction, and impaired left ventricular filling. New England Journal of Medicine, Jan. 21; 362(3):217-227, 2010.
  • COPD Learn More Breathe Better®
  • Multi-Ethnic Study of Atherosclerosis (MESA) Web site
  • ‘What is COPD?’ from the NHLBI Diseases and Conditions Index (DCI)
  • Lung Function Tests from the NHLBI DCI
  • Recovery Act Profile: Meet Dr. Farrah Kheradmand, M.D., who is studying immune modulators of inflammation in severe COPD

Information on the DASH clinical studies:

  • MESA participants were recruited from six communities across the United States: Forsyth County, N.C., New York City, N.Y., Baltimore, Md., St. Paul, Minn., Chicago, Ill., and Los Angeles, Calif. Participants come from diverse races and ethnic groups and have been tracked since enrollment began in 2000.
  • Exclusion criteria for the study included clinical cardiovascular disease, weight exceeding 136 kg (300 lb), and pregnancy.

COPD Learn More Breathe Better® is a trademark of DHHS.

June 2010

Archived page, reproduced from a 2011 copy. It is reference material, not current guidance.