Declining Lung Function and Cardiovascular Risk

Background Pulmonary dysfunction predicts incident cardiovascular disease (CVD). Objectives To evaluate whether longitudinal decline in lung function is associated with incident heart failure (HF), coronary disease (CHD), and stroke. Methods Among 10,351 participants in the 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 second (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, LDL, use of lipid lowering medication, NT-proBNP 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 24%. Rapid decline in FEV1 and in FVC were both associated with a heightened risk of incident HF (HR=1.17, 95% CI 1.04–1.33; p=0.010 and HR=1.27, 95% CI 1.12–1.44; p<0.001, respectively), with rapid decline in FEV1 most prognostic in the first year of follow-up (HR=4.22, 95% CI 1.34–13.26; p=0.01). Rapid decline in FEV1 was also associated with incident stroke (HR=1.25, 95% CI 1.04–1.50; p=0.015). Conclusion Rapid decline in lung function, assessed by serial spirometry, is associated with a higher incidence of subsequent CVD, particularly incident HF.