Pulmonary Vascular Changes in Early Chronic Obstructive Pulmonary
Pulmonary Vascular Changes in Early Chronic Obstructive Pulmonary
The Multi-Ethnic Study of Atherosclerosis (MESA) - Chronic Obstructive Pulmonary Disease
 (COPD) Study aims to characterize the pulmonary vascular changes and their biology in early
 COPD using imaging, gene expression profiling and peripheral cellular measures.
Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the US
 and will soon replace stroke as the third leading cause.

 Translation of promising biological hypotheses of COPD pathogenesis to human populations that
 may lead to new therapies is urgently needed. The vascular hypothesis of COPD was articulated
 almost 50 years ago. Bench research on endothelial dysfunction in COPD is evolving rapidly
 and has shown that acrolein in cigarette smoke causes endothelial apoptosis and endothelial
 apoptosis is directly implicated in COPD pathogenesis. Clinical studies on endothelial
 dysfunction and vascular changes in COPD are limited.

 The proposed study is a longitudinal study of smokers nested among the MESA-Lung (AAAA7791)
 and EMphysema and Cancer Action Project (EMCAP) Studies (AAAA6484), which together provide a
 well-defined cohort of 4,617 participants with prior spirometry and CT measures.

 The Multiethnic Study of Atherosclerosis - Chronic Obstructive Pulmonary Disease (MESA COPD
 Study) has two main scientific purposes:

 1. characterize the pulmonary vascular changes in COPD and their biology, and

 2. propose novel pathways for new therapies in COPD.

 MESA COPD is a longitudinal study of smokers nested within the MESA-Lung and EMCAP cohorts of
 360 participants (160 cases with mild, 60 cases with moderate and 40 cases with severe COPD
 and 100 controls) who will be phenotyped with magnetic resonance (MR) pulmonary angiography,
 pulmonary function testing, full-lung CT scans, serum Vascular Endothelial Growth Factor
 (VEGF), cell assays and gene expression profiling. MESA COPD Study will contribute improving
 the knowledge of early changes in COPD that may lead to novel disease-modifying medical
 therapies and preventative strategies.
Inclusion Criteria:

 -  age 50-79 years at time of enrollment

 -  ever smokers (10 or more pack-years)

 -  participation in MESA or EMCAP studies

 Exclusion Criteria:

 -  clinical cardiovascular disease (left congestive heart failure (CHF), valve disease,
 coronary artery disease (CAD), stroke, or congenital heart disease),

 -  asthma, pulmonary embolism or lung disease other than COPD,

 -  weight > 300 lbs,

 -  chronic renal insufficiency ([estimated glomerular filtration rate (eGFR)] < 45
 mL/min/1.73 m2),

 -  cancer,

 -  atrial fibrillation, and

 -  contraindications to magnetic resonance imagine (MRI), gadolinium, albuterol or
 spirometry testing.