Cardiovascular risk factor burden in preserved ratio impaired spirometry (PRISm): a meta-analysis.

Background Preserved Ratio Impaired Spirometry (PRISm) is considered a precursor to chronic obstructive pulmonary disease (COPD), a condition with well-established cardiovascular (CV) risk. However, it is still uncertain whether this pre-clinical stage is already associated with increased comorbid prevalence of CV burden. Understanding CV burden in PRISm is crucial to determine if CV risk is present before COPD development, informing early screening and preventive strategies. Purpose To quantify the absolute cardiovascular disease (CVD) burden in individuals with PRISm compared to those with normal spirometry. Methods We systematically searched major databases (PubMed, Embase, Web of Science, Cochrane) for studies reporting the prevalence of CVD (any CVD, ischemic heart disease [IHD], heart failure [HF], stroke, peripheral artery disease [PAD], and arrhythmias) and CV risk factors (hypertension [HTN], obesity, ever smoking, diabetes, and dyslipidemia) among adults aged ≥40 years with PRISm versus normal spirometry. PRISm was defined as Forced Expiratory Volume in the 1 second/Forved Vital Capacity (FEV1/FVC) ≥0.70 and impaired FEV1 (FEV1<80% predicted). Normal Spirometry was defined as FEV1/FVC≥0.70 with FEV1≥80% predicted. We conducted random-effects meta-analyses calculating pooled absolute risk differences (ARD) with 95% confidence intervals (95%CI). For each outcome, we also computed excess cases per 1000 individuals, number needed to screen (NNS). Heterogeneity was assessed using I² statistics. Results After screening of eligible studies, we included 45 studies. Compared to those with normal spirometry, individuals with PRISm demonstrated an excess CV burden (Table 1). The highest excess cases per 1000 were observed for hypertension (134 cases, 95% CI 77-192; NNS=7), diabetes (110 cases, 95% CI 17-203; NNS=9), ever smoking (90 cases, 95% CI 25-155; NNS=11), and obesity (98 cases, 95% CI 55-141; NNS=10). Among CVD, excess cases were observed for any CVD (36 cases, 95% CI 10-62; NNS=28), HF (37 cases, 95% CI 24-51; NNS=27), IHD (14; 26 cases, 95% CI 0-52; NNS=38), and stroke (13 cases, 95% CI 9-18; NNS=74), but not arrhythmias. Substantial heterogeneity was observed among CVD and CV risk factors (I² range 0-98%). Conclusion Individuals with PRISm have a high prevalence of CVD and major risk factor for CVD. These findings suggest that CV screening should be initiated at the PRISm stage, before progression to COPD, and that pulmonary function tests should be considered in patients with CVD to identify a respiratory impairment. Early detection and preventive interventions at this precursor stage may reduce CV morbidity.Pooled results of meta-analysis.