Author + information
- Received May 29, 2018
- Accepted June 18, 2018
- Published online August 27, 2018.
- Odilson M. Silvestre, MD, MPHa,b,
- Wilson Nadruz Jr., MDa,c,
- Gabriela Querejeta Roca, MDa,
- Brian Claggett, PhDa,
- Scott D. Solomon, MDa,
- Maria C. Mirabelli, MDd,
- Stephanie J. London, MDe,
- Laura R. Loehr, MDf and
- Amil M. Shah, MD, MPHa,∗ (, )@BrighamWomens
- aDivision of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- bDepartment of Internal Medicine, Federal University of Acre, Rio Branco, Acre, Brazil
- cDepartment of Internal Medicine, University of Campinas, Campinas, Brazil
- dRollins School of Public Health, Emory University, Atlanta, Georgia
- eNational Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina
- fGillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina
- ↵∗Address for correspondence:
Dr. Amil M. Shah, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115.
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.
The ARIC Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). The work for this paper was also supported by National Heart, Lung, and Blood Institute grants K08HL116792 and R01HL135008, American Heart Association grant 14CRP20380422, and the Brigham and Women’s Hospital Heart and Vascular Center Watkins Discovery Award (to Dr. Shah); Brazilian National Council for Scientific and Technological Development Grant 249481/2013-8 (to Dr. Nadruz); and the J.P. Lemann Foundation Jorge Paulo Lemann Harvard Medical School Cardiovascular Fellowship (to Dr. Silvestre). Dr. London is supported by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences (ZO1 ES043012). Dr. Shah has received consulting fees from Bellerophon Therapeutics; and has received research grants through the Brigham and Women's Hospital from Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 29, 2018.
- Accepted June 18, 2018.
- 2018 American College of Cardiology Foundation
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