Lung Function Decline and Disease Risk From Young Adulthood to Middle Age
Condition: COPD; Lung Function; Heart - Lung Interaction; Restrictive Lung Disease
MeSH terms: Lung Diseases
Study type: Observational

Summary: 
      Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the
      United States, but markers that predict risk of developing disease outside of cigarette
      smoking have not been identified. Individuals with lung disease frequently have concurrent
      cardiovascular disease, but the reason for this is not well understood. In this study, we
      will identify markers that predict risk of future lung disease and evaluate the concurrent
      subclinical evolution of lung and heart dysfunction. This will allow for targeting of
      preventive strategies to stop the rising incidence of COPD and other lung diseases and
      provide insights into why heart and lung disease frequently occur together.
    

Detailed description: 
      Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the
      United States. Although smoking is a major risk factor for COPD, only a minority of smokers
      develops COPD. Markers that predict risk of future COPD in young adults would be valuable to
      target risk reduction strategies and identify subclinical disease. Although COPD is
      classically defined by obstructive lung physiology, many individuals, including smokers, have
      spirometric restrictive physiology. Reduced lung function, whether manifesting as COPD or
      restriction, is associated with adverse cardiovascular outcomes. Our long-term goals are to
      identify subclinical manifestations of COPD and other lung disease and explore why heart and
      lung disease co-exist. This is an ancillary study to the Coronary Artery Risk Development in
      Young Adults (CARDIA) cohort study's year 30 examination. We will add pre- and
      post-bronchodilator spirometry to the exam and evaluate the lung parenchymal and vascular
      structure on cardiac CT scans from year 25. Informed by our preliminary data which documents
      that markers of systemic inflammation and endothelial dysfunction are associated with
      subsequent lung function decline in young adults, that lung function decline in young adults
      is associated with incident hypertension, and that there is a divergence in cardiac structure
      and function depending on the pattern of lung function decline, we propose the following
      specific aims: (1) To evaluate factors in young adults that predict incident COPD and/or
      restriction; (2) To determine whether incident COPD and incident restriction are associated
      with distinct cardiac structural and functional changes; and (3) To determine the lung
      structural and intrathoracic vascular changes associated with incident COPD and incident
      restriction. We will test the hypothesis that early life markers of systemic inflammation and
      endothelial dysfunction are associated with risk of subsequent lung disease and explore
      whether different inflammatory markers predict different lung phenotypes. We will then
      evaluate the cardiac structural changes associated with different lung phenotypes and
      evaluate the lung structural and pulmonary vascular alterations that may explain the
      concurrently evolving cardiovascular findings associated with developing lung disease. These
      studies will describe the subclinical manifestations of lung disease, identify markers that
      predict risk of future lung disease, and expand our understanding of heart-lung interactions
      as they evolve from health in young adults to disease in middle age.
    

Intervention name(s): Lung spirometry; CT scan analysis
Intervention type(s): Procedure; Other
Intervention description(s): measurement of pulmonary function pre- and post-bronchodilator; Analysis of existing year 25 thoracic CT scans for lung and intrathoracic vascular structure
Other intervention name(s): lung function
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Participants in the main Coronary Artery Risk Development in Young Adults (CARDIA) cohort
        study attending the year 30 examination