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Rapid decline in FEV1. A new risk factor for coronary heart disease mortality
M S Tockman1, J D Pearson, J L Fleg
1Department of Environmental Health Sciences, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, Maryland 21205.
Insights
A rapid decline in forced expiratory volume in one second (FEV1) predicts coronary heart disease (CHD) mortality in men, independent of other risk factors. This finding highlights lung function decline as a crucial indicator for cardiovascular health.
Area of Science:
- Cardiology
- Pulmonology
- Epidemiology
Background:
- Coronary heart disease (CHD) is a primary cause of death in the U.S.
- Pulmonary function, specifically forced expiratory volume in one second (FEV1), has been investigated for its association with cardiovascular health.
Purpose of the Study:
- To investigate if the rate of FEV1 decline independently predicts CHD mortality in apparently healthy men.
- To assess the relationship between FEV1 decline and all-cause mortality.
Main Methods:
- A cohort study of 883 White male participants from the Baltimore Longitudinal Study of Aging (BLSA) without pre-existing CHD.
- Data collected included pulmonary function tests, lipid profiles, smoking status, blood pressure, and body mass index.
- A time-dependent proportional hazards model was used to analyze CHD mortality over an average follow-up of 17.4 years.
Main Results:
- An increased rate of FEV1 decline was associated with significantly higher cardiac mortality (relative risk [RR] 2.92-5.13).
- This association remained significant even after adjusting for age, initial FEV1, smoking, hypertension, and cholesterol levels.
- No significant association was found between FEV1 decline and all-cause mortality.
Conclusions:
- Accelerated FEV1 decline is an independent predictor of CHD mortality in men.
- Lung function decline may serve as an early warning sign for cardiovascular risk.
- These findings emphasize the importance of considering pulmonary health in cardiovascular risk assessment.
Abstract:
Coronary heart disease (CHD) is the leading cause of mortality in the United States. The present cohort study was conducted to determine whether rate of FEV1 loss independently predicts CHD mortality in apparently healthy men. White male Baltimore Longitudinal Study of Aging (BLSA) participants without CHD underwent clinical evaluation at 2-yr intervals; 883 had satisfactory pulmonary and lipid studies and returned for a least one visit. Cases were BLSA subjects without CHD on entry who died a "coronary death" (death from acute myocardial infarction, sudden death, or congestive heart failure in the presence of coronary artery disease). Forced expiratory maneuvers followed American Thoracic Society guidelines. Serum cholesterol, blood pressure, cigarette smoking, and body mass index were obtained from the BLSA database. There were 79 CHD deaths and 804 survivors during an average follow-up of 17.4 yr. After adjustment for age, initial FEV1% predicted, smoking status, hypertension, and cholesterol, a time-dependent proportional hazards model showed that cardiac mortality, but not all causes of mortality, generally increased with increasing quintile of FEV1 decline for the entire cohort (relative risk [RR] 2.92-5.13) and separately for the subset of never-smokers. Thus, excess CHD mortality follows a large decline in FEV1, independent of the initial FEV1% predicted, cigarette smoking, and other common CHD risk factors.