A Longitudinal Cohort Study of Aspirin Use and Progression of Emphysema-like Lung Characteristics on CT Imaging

The MESA Lung Study

Carrie P. Aaron*, Joseph E. Schwartz, Eric A. Hoffman, Elsa Angelini, John H.M. Austin, Mary Cushman, David R. Jacobs, Joel D. Kaufman, Andrew Laine, Lewis J Smith, Jie Yang, Karol E. Watson, Russell P. Tracy, R. Graham Barr

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Platelet activation reduces pulmonary microvascular blood flow and contributes to inflammation; these factors have been implicated in the pathogenesis of COPD and emphysema. We hypothesized that regular use of aspirin, a platelet inhibitor, would be associated with a slower progression of emphysema-like lung characteristics on CT imaging and a slower decline in lung function. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) enrolled participants 45 to 84 years of age without clinical cardiovascular disease from 2000 to 2002. The MESA Lung Study assessed the percentage of emphysema-like lung below –950 Hounsfield units (“percent emphysema”) on cardiac (2000-2007) and full-lung CT scans (2010-2012). Regular aspirin use was defined as 3 or more days per week. Mixed-effect models adjusted for demographics, anthropometric features, smoking, hypertension, angiotensin-converting enzyme inhibitor or angiotensin II-receptor blocker use, C-reactive protein levels, sphingomyelin levels, and scanner factors. Results: At baseline, the 4,257 participants' mean (± SD) age was 61 ± 10 years, 54% were ever smokers, and 22% used aspirin regularly. On average, percent emphysema increased 0.60 percentage points over 10 years (95% CI, 0.35-0.94). Progression of percent emphysema was slower among regular aspirin users compared with patients who did not use aspirin (fully adjusted model: –0.34% /10 years, 95% CI, –0.60 to –0.08; P =.01). Results were similar in ever smokers and with doses of 81 and 300 to 325 mg and were of greater magnitude among those with airflow limitation. No association was found between aspirin use and change in lung function. Conclusions: Regular aspirin use was associated with a more than 50% reduction in the rate of emphysema progression over 10 years. Further study of aspirin and platelets in emphysema may be warranted.

Original languageEnglish (US)
Pages (from-to)41-50
Number of pages10
JournalCHEST
Volume154
Issue number1
DOIs
StatePublished - Jul 1 2018

Fingerprint

Emphysema
Aspirin
Longitudinal Studies
Atherosclerosis
Cohort Studies
Lung
Sphingomyelins
Angiotensin Receptor Antagonists
Platelet Aggregation Inhibitors
Platelet Activation
Angiotensin-Converting Enzyme Inhibitors
C-Reactive Protein
Chronic Obstructive Pulmonary Disease
Cardiovascular Diseases
Blood Platelets
Smoking
Demography
Hypertension
Inflammation

Keywords

  • COPD
  • CT
  • platelets

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Aaron, C. P., Schwartz, J. E., Hoffman, E. A., Angelini, E., Austin, J. H. M., Cushman, M., ... Barr, R. G. (2018). A Longitudinal Cohort Study of Aspirin Use and Progression of Emphysema-like Lung Characteristics on CT Imaging: The MESA Lung Study. CHEST, 154(1), 41-50. https://doi.org/10.1016/j.chest.2017.11.031
Aaron, Carrie P. ; Schwartz, Joseph E. ; Hoffman, Eric A. ; Angelini, Elsa ; Austin, John H.M. ; Cushman, Mary ; Jacobs, David R. ; Kaufman, Joel D. ; Laine, Andrew ; Smith, Lewis J ; Yang, Jie ; Watson, Karol E. ; Tracy, Russell P. ; Barr, R. Graham. / A Longitudinal Cohort Study of Aspirin Use and Progression of Emphysema-like Lung Characteristics on CT Imaging : The MESA Lung Study. In: CHEST. 2018 ; Vol. 154, No. 1. pp. 41-50.
@article{278b71d1c3a5446e8bd46e9676c266f3,
title = "A Longitudinal Cohort Study of Aspirin Use and Progression of Emphysema-like Lung Characteristics on CT Imaging: The MESA Lung Study",
abstract = "Background: Platelet activation reduces pulmonary microvascular blood flow and contributes to inflammation; these factors have been implicated in the pathogenesis of COPD and emphysema. We hypothesized that regular use of aspirin, a platelet inhibitor, would be associated with a slower progression of emphysema-like lung characteristics on CT imaging and a slower decline in lung function. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) enrolled participants 45 to 84 years of age without clinical cardiovascular disease from 2000 to 2002. The MESA Lung Study assessed the percentage of emphysema-like lung below –950 Hounsfield units (“percent emphysema”) on cardiac (2000-2007) and full-lung CT scans (2010-2012). Regular aspirin use was defined as 3 or more days per week. Mixed-effect models adjusted for demographics, anthropometric features, smoking, hypertension, angiotensin-converting enzyme inhibitor or angiotensin II-receptor blocker use, C-reactive protein levels, sphingomyelin levels, and scanner factors. Results: At baseline, the 4,257 participants' mean (± SD) age was 61 ± 10 years, 54{\%} were ever smokers, and 22{\%} used aspirin regularly. On average, percent emphysema increased 0.60 percentage points over 10 years (95{\%} CI, 0.35-0.94). Progression of percent emphysema was slower among regular aspirin users compared with patients who did not use aspirin (fully adjusted model: –0.34{\%} /10 years, 95{\%} CI, –0.60 to –0.08; P =.01). Results were similar in ever smokers and with doses of 81 and 300 to 325 mg and were of greater magnitude among those with airflow limitation. No association was found between aspirin use and change in lung function. Conclusions: Regular aspirin use was associated with a more than 50{\%} reduction in the rate of emphysema progression over 10 years. Further study of aspirin and platelets in emphysema may be warranted.",
keywords = "COPD, CT, platelets",
author = "Aaron, {Carrie P.} and Schwartz, {Joseph E.} and Hoffman, {Eric A.} and Elsa Angelini and Austin, {John H.M.} and Mary Cushman and Jacobs, {David R.} and Kaufman, {Joel D.} and Andrew Laine and Smith, {Lewis J} and Jie Yang and Watson, {Karol E.} and Tracy, {Russell P.} and Barr, {R. Graham}",
year = "2018",
month = "7",
day = "1",
doi = "10.1016/j.chest.2017.11.031",
language = "English (US)",
volume = "154",
pages = "41--50",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "1",

}

Aaron, CP, Schwartz, JE, Hoffman, EA, Angelini, E, Austin, JHM, Cushman, M, Jacobs, DR, Kaufman, JD, Laine, A, Smith, LJ, Yang, J, Watson, KE, Tracy, RP & Barr, RG 2018, 'A Longitudinal Cohort Study of Aspirin Use and Progression of Emphysema-like Lung Characteristics on CT Imaging: The MESA Lung Study', CHEST, vol. 154, no. 1, pp. 41-50. https://doi.org/10.1016/j.chest.2017.11.031

A Longitudinal Cohort Study of Aspirin Use and Progression of Emphysema-like Lung Characteristics on CT Imaging : The MESA Lung Study. / Aaron, Carrie P.; Schwartz, Joseph E.; Hoffman, Eric A.; Angelini, Elsa; Austin, John H.M.; Cushman, Mary; Jacobs, David R.; Kaufman, Joel D.; Laine, Andrew; Smith, Lewis J; Yang, Jie; Watson, Karol E.; Tracy, Russell P.; Barr, R. Graham.

In: CHEST, Vol. 154, No. 1, 01.07.2018, p. 41-50.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A Longitudinal Cohort Study of Aspirin Use and Progression of Emphysema-like Lung Characteristics on CT Imaging

T2 - The MESA Lung Study

AU - Aaron, Carrie P.

AU - Schwartz, Joseph E.

AU - Hoffman, Eric A.

AU - Angelini, Elsa

AU - Austin, John H.M.

AU - Cushman, Mary

AU - Jacobs, David R.

AU - Kaufman, Joel D.

AU - Laine, Andrew

AU - Smith, Lewis J

AU - Yang, Jie

AU - Watson, Karol E.

AU - Tracy, Russell P.

AU - Barr, R. Graham

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background: Platelet activation reduces pulmonary microvascular blood flow and contributes to inflammation; these factors have been implicated in the pathogenesis of COPD and emphysema. We hypothesized that regular use of aspirin, a platelet inhibitor, would be associated with a slower progression of emphysema-like lung characteristics on CT imaging and a slower decline in lung function. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) enrolled participants 45 to 84 years of age without clinical cardiovascular disease from 2000 to 2002. The MESA Lung Study assessed the percentage of emphysema-like lung below –950 Hounsfield units (“percent emphysema”) on cardiac (2000-2007) and full-lung CT scans (2010-2012). Regular aspirin use was defined as 3 or more days per week. Mixed-effect models adjusted for demographics, anthropometric features, smoking, hypertension, angiotensin-converting enzyme inhibitor or angiotensin II-receptor blocker use, C-reactive protein levels, sphingomyelin levels, and scanner factors. Results: At baseline, the 4,257 participants' mean (± SD) age was 61 ± 10 years, 54% were ever smokers, and 22% used aspirin regularly. On average, percent emphysema increased 0.60 percentage points over 10 years (95% CI, 0.35-0.94). Progression of percent emphysema was slower among regular aspirin users compared with patients who did not use aspirin (fully adjusted model: –0.34% /10 years, 95% CI, –0.60 to –0.08; P =.01). Results were similar in ever smokers and with doses of 81 and 300 to 325 mg and were of greater magnitude among those with airflow limitation. No association was found between aspirin use and change in lung function. Conclusions: Regular aspirin use was associated with a more than 50% reduction in the rate of emphysema progression over 10 years. Further study of aspirin and platelets in emphysema may be warranted.

AB - Background: Platelet activation reduces pulmonary microvascular blood flow and contributes to inflammation; these factors have been implicated in the pathogenesis of COPD and emphysema. We hypothesized that regular use of aspirin, a platelet inhibitor, would be associated with a slower progression of emphysema-like lung characteristics on CT imaging and a slower decline in lung function. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) enrolled participants 45 to 84 years of age without clinical cardiovascular disease from 2000 to 2002. The MESA Lung Study assessed the percentage of emphysema-like lung below –950 Hounsfield units (“percent emphysema”) on cardiac (2000-2007) and full-lung CT scans (2010-2012). Regular aspirin use was defined as 3 or more days per week. Mixed-effect models adjusted for demographics, anthropometric features, smoking, hypertension, angiotensin-converting enzyme inhibitor or angiotensin II-receptor blocker use, C-reactive protein levels, sphingomyelin levels, and scanner factors. Results: At baseline, the 4,257 participants' mean (± SD) age was 61 ± 10 years, 54% were ever smokers, and 22% used aspirin regularly. On average, percent emphysema increased 0.60 percentage points over 10 years (95% CI, 0.35-0.94). Progression of percent emphysema was slower among regular aspirin users compared with patients who did not use aspirin (fully adjusted model: –0.34% /10 years, 95% CI, –0.60 to –0.08; P =.01). Results were similar in ever smokers and with doses of 81 and 300 to 325 mg and were of greater magnitude among those with airflow limitation. No association was found between aspirin use and change in lung function. Conclusions: Regular aspirin use was associated with a more than 50% reduction in the rate of emphysema progression over 10 years. Further study of aspirin and platelets in emphysema may be warranted.

KW - COPD

KW - CT

KW - platelets

UR - http://www.scopus.com/inward/record.url?scp=85044508285&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044508285&partnerID=8YFLogxK

U2 - 10.1016/j.chest.2017.11.031

DO - 10.1016/j.chest.2017.11.031

M3 - Article

VL - 154

SP - 41

EP - 50

JO - Chest

JF - Chest

SN - 0012-3692

IS - 1

ER -