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Lung Function and Ischemic Stroke Incidence^*

The Atherosclerosis Risk in Communities Study

^* From the Division of Epidemiology and Community Health (Drs. Hozawa, Shahar, Ohira, and Folsom), School of Public Health, and the Department of Medicine (Dr. Billings), University of Minnesota, Minneapolis, MN; and the Department of Epidemiology (Dr. Rosamond), University of North Carolina, Chapel Hill, NC.

Correspondence to: Aaron R. Folsom, MD, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South Second St, Suite 300, Minneapolis, MN 55454-1015; e-mail: folsom{at}epi.umn.edu

Abstract

Background: Few studies have examined the relation between lung function and ischemic stroke incidence; none have studied African Americans.

Methods: We followed 13,842 middle-aged adults initially free of stroke and coronary heart disease and observed 472 incident ischemic strokes over 13 years. Quartiles of FEV₁ as a percentage of predicted value (FEV₁PP) and FVC as a percentage of a predicted value (FVCPP) were used as the indicators of lung function.

Results: In the age-, race-, gender-, and education-adjusted models, both lung function measures were significantly inversely related to ischemic stroke incidence (linear trend for FEV₁PP, p < 0.01; linear trend for FVCPP, p < 0.01), but adjustment for possible confounders attenuated these relations. For white subjects, a significant inverse relation remained even after full adjustment (relative hazards [RH] across FEV₁PP quartiles (lowest to highest) were 1.59, 1.52, 1.26, and 1.00; and for FVCPP quartiles were 1.56, 1.80, 1.09, and 1.00 [trend for both, p < 0.05]). There was no association for African Americans (RH across FEV₁PP and FVCPP quartiles were 0.74, 0.89, 0.73, 1.00 [linear trend, p = 0.27] and 0.81, 1.07, 0.61, 1.00 [linear trend, p = 0.75], respectively). An inverse relation between lung function and ischemic stroke was also observed among white subjects who never smoked (FEV₁PP) or had no respiratory symptoms (both FEV₁PP and FVCPP) but not among their African-American counterparts.

Conclusions: Among white subjects, participants with impaired lung function have a modestly higher risk of ischemic stroke even if they have never smoked nor had respiratory symptoms.

Key Words: cigarette smoking • ischemic stroke • lung function • prospective study • respiratory symptom

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