Chest
Volume 127, Issue 6, June 2005, Pages 1952-1959
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Clinical Investigations
The Relationship Between Reduced Lung Function and Cardiovascular Mortality: A Population-Based Study and a Systematic Review of the Literature

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Study objectives

Conditions that give rise to reduced lung function are frequently associated with low-grade systemic inflammation, which may lead to poor cardiovascular outcomes. We sought to determine the relationship between reduced FEV1 and cardiovascular mortality, independent of smoking.

Design

Longitudinal population-based study and a metaanalysis of literature.

Setting

Representative sample of the general population.

Participants

Participants of the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study who were 40 to 60 years of age at baseline assessment (n = 1,861).

Measurements and results

We compared the risk of cardiovascular mortality across quintiles of FEV1. Individuals in the lowest FEV1 quintile had the highest risk of cardiovascular mortality (relative risk [RR], 3.36; 95% confidence interval [CI], 1.54 to 7.34). Compared to FEV1 quintile 1, individuals in quintile 5 had a fivefold increase in the risk of death from ischemic heart disease (RR, 5.65; 95% CI, 2.26 to 14.13). We also performed a systematic review of large cohort studies (> 500 participants) that reported on the relationship between FEV1 and cardiovascular mortality (12 studies; n = 83,880 participants). Compared to participants in the highest FEV1 category, those with reduced FEV1 had a higher risk of cardiovascular mortality (pooled RR, 1.77; 95% CI, 1.56 to 1.97).

Conclusions

There is strong epidemiologic evidence to indicate that reduced FEV1 is a marker for cardiovascular mortality independent of age, gender, and smoking history.

Section snippets

Study Population

Originally, 20,729 Americans participated in the first National Health and Nutrition Examination Survey (NHANES) from 1971 through 1975; of these, 14,407 persons underwent a detailed medical examination. They were followed up longitudinally until 1992 as part of the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study (NHEFS).10 The data for the NHEFS were collected in four waves. The details of cohort assemblage and follow-up are provided elsewhere.10 In brief, the

NHEFS

In total, there were 1,861 adult participants in this study. The mean age of the participants was 50 ± 5.7 years; 47.1% (n = 876) were men, 9.4% (n = 174) were African-Americans, and 37.2% (n = 693) were active smokers. The mean systolic and diastolic BP values were 133.8 ± 20.2 mm Hg and 85.3 ± 11.6 mm Hg, respectively (± SD). The mean BMI was 26.0 ± 4.9 kg/m2. The clinical characteristics of the study participants in the different FEV1 quintiles are summarized in Table 1.

Overall, 19.1% (n =

Discussion

The NHANES 1 follow-up data indicate that reduced FEV1 is a marker for future cardiovascular morbidity and mortality. The relationship between reduced FEV1 and mortality from ischemic heart disease was particularly striking. Even a modest decline in FEV1 (from a mean of 109% of predicted to 88% of predicted) was associated with a fivefold increase in deaths from ischemic heart disease, independent of baseline smoking status and other potential confounding factors such as age, gender, and

References (38)

  • CurbJD et al.

    Smoking, pulmonary function, and mortality

    Ann Epidemiol

    (1990)
  • CamilliAE et al.

    Death certificate reporting of confirmed airways obstructive disease

    Am J Epidemiol

    (1991)
  • SinDD et al.

    Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease

    Circulation

    (2003)
  • EidAA et al.

    Inflammatory response and body composition in chronic obstructive pulmonary disease

    Am J Respir Crit Care Med

    (2001)
  • TakabatakeN et al.

    The relationship between chronic hypoxemia and activation of the tumor necrosis factor-α system in patients with chronic obstructive pulmonary disease

    Am J Respir Crit Care Med

    (2000)
  • AnthonisenNR et al.

    Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1: the Lung Health Study

    JAMA

    (1994)
  • Multiple Risk Factor Intervention Trial Research Group. Multiple Risk Factor Intervention Trial: risk factor changes and mortality results

    JAMA

    (1982)
  • CoxCS et al.

    Plan and operation of the NHANES I Epidemiologic Follow-up Study, 1992. National Center for Health Statistics

    Vital Health Stat

    (1997)
  • National Center for Health Statistics

    Computer-assisted spirometry data analysis for the National Health and Nutrition Examination Survey, 1971–75

    (1981)
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    Dr. Sin is supported by a Canada Research Chair (Respiration) and a Michael Smith/St. Paul's Hospital Foundation Professorship in COPD.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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