Declining Lung Function and Cardiovascular Risk The ARIC Study

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:72

Article

Silvestre, Odilson M.^1,2  Nadruz, Wilson, Jr.^1,3  Roca, Gabriela Querejeta¹  Claggett, Brian¹  Solomon, Scott D.¹  Mirabelli, Maria C.⁴  London, Stephanie J.⁵  Loehr, Laura R.⁶  Shah, Amil M.¹ 

[1] Brigham & Womens Hosp, Div Cardiovasc Med, 75 Francis St, Boston, MA 02115 USA

[2] Univ Fed Acre, Dept Internal Med, Rio Branco, Acre, Brazil

[3] Univ Estadual Campinas, Dept Internal Med, Campinas, SP, Brazil

[4] Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA

[5] NIEHS, NIH, Dept Hlth & Human Serv, POB 12233, Res Triangle Pk, NC 27709 USA

[6] Univ N Carolina, Gillings Sch Publ Hlth, Chapel Hill, NC 27515 USA

关键词: cardiovascular disease;    FEV1;    FVC;    heart failure;    lung function;   

DOI  :  10.1016/j.jacc.2018.06.049

来源: Elsevier

【 摘 要 】

BACKGROUND Pulmonary dysfunction predicts incident cardiovascular disease (CVD). OBJECTIVES The purpose of this study was to evaluate whether longitudinal decline in lung function is associated with incident heart failure (HF), coronary heart disease (CHD), and stroke. METHODS Among 10,351 participants in the ARIC (Atherosclerosis Risk In Communities) study free of CVD, rapid lung function decline was defined as the greatest quartile (n = 2,585) of decline in either forced expiratory volume in 1 s (FEV1) (> 1.9% decline/year) or forced vital capacity (FVC) (>2.1% decline/year) over 2.9 +/- 0.2 years. The relationship between rapid decline in FEV1 or FVC and subsequent incident HF, CHD, stroke, or a composite of these was assessed using multivariable Cox regression adjusting for the baseline spirometry value, demographics, height, body mass index, heart rate, diabetes, hypertension, low-density lipoprotein, use of lipid-lowering medication, N-terminal fragment of prohormone for B-type natriuretic peptide, and smoking. RESULTS The mean age was 54 +/- 6 years, 56% were women, and 81% were white. At 17 +/- 6 years of follow-up, HF occurred in 14%, CHD 11%, stroke 6%, and the composite in 24%. Rapid decline in FEV1 and in FVC were both associated with a heightened risk of incident HF (hazard ratio [HR]: 1.17; 95% confidence interval [CI]: 1.04 to 1.33; p = 0.010; and HR: 1.27; 95% CI: 1.12 to 1.44; p < 0.001; respectively), with rapid decline in FEV1 most prognostic in the first year of follow-up (HR: 4.22; 95% CI: 1.34 to 13.26; p 0.01). Rapid decline in FEV1 was also associated with incident stroke (HR: 1.25; 95% CI: 1.04 to 1.50; p = 0.015). CONCLUSIONS A rapid decline in lung function, assessed by serial spirometry, is associated with a higher incidence of subsequent CVD, particularly incident HF. (C) 2018 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.

【 授权许可】

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