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Lower Pulmonary Function and Cerebral Subclinical Abnormalities Detected by MRI^*

The Atherosclerosis Risk in Communities Study

^* From the Department of Health Evaluation Sciences (Dr. Liao), Penn State University College of Medicine, Hershey, PA; the Department of Epidemiology (Dr. Higgins), School of Public Health, University of Michigan, Ann Arbor, MI; the Department of Radiology (Dr. Bryan), Johns Hopkins University School of Medicine, Baltimore, MD; the Department of Epidemiology (Drs. Eigenbrodt and Heiss, and Ms. Lamar) and the Department of Biostatistics (Dr. Chambless), School of Public Health, University of North Carolina, Chapel Hill, NC; and the Department of Public Health Sciences (Dr. Burke), Wake Forest University School of Medicine, Winston-Salem, NC.

Correspondence to: Duanping Liao, MD, PhD, Department of Health Evaluation Sciences, Penn State University College of Medicine, H173, 500 University Drive, Hershey, PA 17033; e-mail: DLiao{at}psu.edu

Study objectives: To investigate the association between pulmonary function and (1) cerebral infarction and (2) white matter lesions (WMLs), identified by MRI and believed to represent subclinical lesions of arteriosclerosis, generalized hypoperfusion, or ischemia of the brain.

Design: Population-based, cross-sectional study.

Setting: Two communities in the United States.

Participants: A sample of 1,917 African-American and white men and women 55 to 72 years old who were selected from the second follow-up examination of the Atherosclerosis Risk in Communities Study cohort.

Interventions: Observational study.

Measurements and results: The lung function indexes, FEV₁ and FVC, were assessed according to American Thoracic Society criteria. Subclinical cerebral infarction and WMLs were assessed by MRI. After adjusting for age, ethnicity, gender, height, and height squared, a 1-SD decrease of FEV₁ in nonsmokers was associated with odds ratios (95% confidence interval [CI], 1.31 to 2.03) of 1.63 for infarction and 1.35 (95% CI, 1.08 to 1.69) for WMLs. Of those in the lowest quartile of FEV₁, 15% had infarction and WMLs, in contrast to 6% of the individuals in the uppermost quartile of FEV₁. Consistent associations were also observed by using FVC as an index of pulmonary function. Similar patterns of association were found among current smokers. The associations were not altered by additional adjustment of conventional risk factors of cardiovascular disease, comorbidity, or cognitive function.

Conclusion: The results from this population-based study suggest that lower pulmonary function is associated with subclinical cerebral abnormalities.

Key Words: cardiovascular disease risk factors • cerebral infarction • ethnicity • lung function test • MRI • white matter lesions

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