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Relationship between decline in lung function and cardiovascular risk

02.09.22 05:36 AM Comment(s) By America

By América Torres
lung function
Photo Lifestyle memory / Freepik

The decline in lung function begins around the age of 25: an annual FEV1 drop between 25 and 30 ml is considered normal. Among influencing factors we can include smoking, environmental and behavioral factors and genetics. While this is a well-known predictor of COPD and is associated with coronary heart disease, its role in cardiovascular events is still unclear.


The ARIC (Atherosclerosis Risk in Communities) clinical trial by Odilson M. Silvestre, MD, MPH was an attempt to find the relationship between deterioration in lung function and cardiovascular risk.

Previously, other studies have demonstrated the relationship between accelerated loss of lung function and:

  • Systemic inflammatory response
  • Vascular elasticity impairment
  • Hypertension
  • Coronary heart disease due to atherosclerosis
  • Ischemic stroke
  • Heart failure


All of this led the authors of this study to wonder if an accelerated decline in lung function could predict cardiovascular events such as heart failure, coronary heart disease and stroke. Here's a summary of their findings.


The ARIC study

This clinical trial consisted of a cohort of 15,792 people, who at the time were between 45 and 64 years old.


The results of this document considered only 10,351 participants who underwent spirometry in visit 1 (1987 to 1989) and 2 (1990 to 1992). They excluded individuals who had had prevalent heart failure (n= 700), coronary heart disease (n= 661) and stroke (n= 177). Likewise, those who did not present heart failure (n = 234) or death (n = 1) were excluded, as well as those who did not have spirometry records in visits 1 or 2 (n = 312). Subjects with spirometry lasting <6 seconds, with irregular traces or who, according to the criteria of the ATS, were not reproducible (n = 1,912) were also left out.

Methodology of the ARIC study

  • Among participants who did not have cardiovascular disease, rapid lung function decline was defined as the largest quartile (n = 2,585) of FEV1 decline (>1.9% decline per year) or FVC (>2.1% decline per year) over a period of 2.9 ± 0.2 years.
  • The correlation between rapid deterioration in FEV1 or FVC and subsequent events such as heart failure, heart disease, stroke or a mixture of these, was obtained using a multivariable COX regression model adjusted to:

- Baseline value of spirometry

- Demographics

- Height

- Body Mass Index (BMI)

- Heart rate

- Diabetes

- Hypertension

- Low-density

- Use of statins

- Presence of the N-terminal fragment of the B-type natriuretic pro-peptide (NT-proBNP)

- Smoking

Results and conclusion

  • The mean age of participants in the ARIC study was 54 ± 6 years.
  • 56% were women and 81% were white.
  • At 17 ± 6 years of patient follow-up:

- 14% suffered heart failure

- 11% coronary heart disease

- 6% stroke

- 24% a composite of all the above

  • The rapid decline in both FEV1 and FVC was associated with an increased hazard ratio (HR) of 1.17; 95% with an confidence interval (CI) of 1.04 to 1.33; p=" 0.010;HR: 1.27; 95% CI: 1.12 to 1.44; p <0.001 respectively) with rapid deterioration of FEV1 as the most frequent prognosis 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 stroke (HR: 1.25; 95% CI 1.04 to 1.50; p = 0.015).

The researchers concluded that the rapid deterioration of lung function, assessed by serial spirometry, was associated to a higher incidence of cardiovascular disease, mainly incident heart failure.


Source: Declining Lung Function and Cardiovascular Risk The ARIC Study


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