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Increased incidence of myocardial infarction and stroke in hypertensive men with reduced lung function
G Engström1, B Hedblad, S Valind
1Department of Community Medicine, Malmö University Hospital, Sweden. Gunnar.Engstrom@smi.mas.lu.se
Insights
Reduced lung function amplifies cardiovascular disease and mortality risks in hypertensive individuals. This association between hypertension and lung function, specifically forced expiratory volume (FEV), is independent of smoking.
Area of Science:
- Cardiology
- Pulmonology
- Epidemiology
Background:
- Hypertension is a known risk factor for cardiovascular disease.
- Individual susceptibility to cardiovascular disease varies despite hypertension.
- Lung function may play a role in this variation.
Purpose of the Study:
- To investigate the association between lung function and cardiovascular disease risk in individuals with and without hypertension.
- To determine if lung function modifies the risk of stroke, cardiac events, and mortality in hypertensive men.
Main Methods:
- Population-based prospective cohort study of 639 men born in 1914 in Malmö, Sweden.
- Follow-up for 28 years, assessing mortality, stroke, and cardiac events.
- Analysis of height-adjusted forced expiratory volume in 1 second (FEV1.0) in relation to blood pressure and outcomes.
Main Results:
- Hypertensive men with lower FEV1.0 had significantly higher rates of stroke, cardiac events, and mortality compared to those with higher FEV1.0.
- Men with normal blood pressure and lower FEV1.0 also showed increased rates of stroke, cardiac events, and mortality, with FEV1.0 significantly associated with mortality after adjustments.
- These synergistic interactions between hypertension and reduced lung function were observed independently of smoking and other confounders.
Conclusions:
- Reduced lung function exacerbates cardiovascular disease incidence and mortality in hypertensive individuals.
- Lung function is an independent predictor of cardiovascular outcomes and mortality, particularly in the context of hypertension.
Background And Objective:
Although hypertension is associated with increased cardiovascular risk, many individuals remain free from disease. This study is aimed to investigate whether this variation in individual susceptibility is associated with lung function.
Design:
Population-based prospective cohort study.
Participants:
'Men born in 1914', Malmö, Sweden. Subjects (n = 639) were examined and considered free from prevalent cardiovascular disease at age 55 years.
Main Outcome Measures:
Mortality, fatal and non-fatal stroke and cardiac events (fatal or non-fatal myocardial infarction) during 28-years follow-up.
Results:
Of the men, 467 had normal blood pressure and 172 (27%) had hypertension (> or = 160/95 mmHg or treatment for hypertension). Hypertensive men with height-adjusted forced expiratory volume during 1 s (FEV1.0) below median had significantly higher rates of stroke (13.4 versus 5.8/1,000 person-years), cardiac events (27.1 versus 12.8/1,000 person-years) and all cause mortality (52.5 versus 28.6/1,000 person-years) than hypertensive men with high FEV1.0. These differences remained statistically significant after adjustment for potential confounders. Men with normal blood pressure and FEV1.0 below median had higher rates of stroke (5.4 versus 4.2/1,000 person-years), cardiac events (13.3 versus 11.6/1,000 person-years) and all cause mortality (29.9 versus 21.2/1,000 person-years) than men with normal blood pressure and high FEV1.0. After adjustments for potential confounders, FEV1.0 was significantly associated with mortality among men with normal blood pressure, whereas the associations with stroke and cardiac events did not reach significance.
Conclusion:
The incidence of cardiovascular disease and death associated with hypertension is increased among men with reduced lung function. The synergistic interaction between hypertension and lung function was independent of smoking and other potential confounders.