Cardiometabolic risk and mortality in PRISm versus COPD: a systematic review and meta-analysis

To evaluate and compare the risks of cardiometabolic comorbidities and all-cause mortality between individuals with preserved ratio impaired spirometry (PRISm) and those with chronic obstructive pulmonary disease (COPD). A systematic literature search was conducted across CNKI, Wanfang Database, VIP Database, SinoMed, PubMed, Embase, Web of Science, and the Cochrane Library from inception to February 2026 to identify observational studies comparing PRISm (FEV₁/FVC ≥ 0.70 and FEV₁ < 80% predicted) with COPD (FEV₁/FVC < 0.70). Meta-analysis was performed using RevMan 5.4. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models, and subgroup analyses were conducted by geographic region. Twenty-two observational studies (n = 343,849) were included, involving 125,776 participants with PRISm and 218,073 with COPD. Compared with COPD, PRISm was associated with significantly higher risks of cardiometabolic conditions, including diabetes [OR = 1.56, 95% CI (1.34-1.82)], obesity [OR = 1.72, 95% CI (1.10-2.68)], and hypertension [OR = 1.15, 95% CI (1.09-1.21)] (P < 0.05). No significant differences were found regarding heart failure, coronary heart disease, or all-cause mortality (P > 0.05). Subgroup analyses revealed that diabetes risk was higher in Western populations (P = 0.002), while all-cause mortality was lower in the PRISm group than in the COPD group specifically among Asian populations (P < 0.001). PRISm is associated with higher risks of hypertension, diabetes, and obesity compared with COPD, highlighting cardiometabolic dysfunction as an important clinical feature. Although the all-cause mortality risk of PRISm was comparable to that of COPD, ethnic heterogeneity was observed in its clinical characteristics. These findings suggest that PRISm may represents a clinically important and heterogeneous lung function phenotype requiring greater clinical attention.