@article {1433581,
	title = {Pectoralis muscle area and mortality in smokers without airflow obstruction},
	journal = {Respir Res},
	volume = {19},
	number = {1},
	year = {2018},
	month = {2018 04 10},
	pages = {62},
	abstract = {BACKGROUND: Low muscle mass is associated with increased mortality in the general population but its prognostic value in at-risk smokers, those without expiratory airflow obstruction, is unknown. We aimed to test the hypothesis that reduced muscle mass is associated with increased mortality in at-risk smokers.

METHODS: Measures of both pectoralis and paravertebral erector spinae muscle cross-sectional area (PMA and PVMA, respectively) as well as emphysema on chest computed tomography (CT) scans were performed in 3705 current and former at-risk smokers (>=10 pack-years) aged 45-80~years enrolled into the COPDGene Study between 2008 and 2013. Vital status was ascertained through death certificate. The association between low muscle mass and mortality was assessed using Cox regression analysis.

RESULTS: During a median of 6.5~years of follow-up, 212 (5.7\%) at-risk smokers died. At-risk smokers in the lowest (vs. highest) sex-specific quartile of PMA but not PVMA had 84\% higher risk of death in adjusted models for demographics, smoking, dyspnea, comorbidities, exercise capacity, lung function, emphysema on CT, and coronary artery calcium content (hazard ratio [HR] 1.85 95\% Confidence interval [1.14-3.00] P = 0.01). Results were consistent when the PMA index (PMA/height) was used instead of quartiles. The association between PMA and death was modified by smoking status (P = 0.04). Current smokers had a significantly increased risk of death (lowest vs. highest PMA quartile, HR 2.25 [1.25-4.03] P = 0.007) while former smokers did not.

CONCLUSIONS: Low muscle mass as measured on chest CT scans is associated with increased mortality in current smokers without airflow obstruction.

TRIAL REGISTRATION: NCT00608764.},
	keywords = {Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mortality, Muscle Strength, Pectoralis Muscles, Pulmonary Disease, Chronic Obstructive, Risk Factors, Smokers, Smoking, Tomography, X-Ray Computed},
	issn = {1465-993X},
	doi = {10.1186/s12931-018-0771-6},
	author = {Diaz, Alejandro A and Martinez, Carlos H and Harmouche, Rola and Young, Thomas P and McDonald, Merry-Lynn and Ross, James C and Han, Mei Lan and Bowler, Russell and Make, Barry and Regan, Elizabeth A and Silverman, Edwin K and Crapo, James and Boriek, Aladin M and Kinney, Gregory L and Hokanson, John E and Estepar, Raul San Jose and Washko, George R}
}