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The Relationship Between Reduced Lung Function and Cardiovascular Mortality^*

A Population-Based Study and a Systematic Review of the Literature

^* From the Department of Medicine, Respiratory Division, University of British Columbia, and The James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St Paul’s Hospital, Vancouver, BC, Canada.

Correspondence to: Don D. Sin, MD, MPH, FCCP, James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St. Paul’s Hospital, Room 368A, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada; e-mail: dsin{at}mrl.ubc.ca

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.

Key Words: cardiovascular mortality • FEV₁ • lung function • metaanalysis • National Health and Nutrition Examination Survey

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