Department of Geriatric Medicine Ullevaal, Institute of Clinical Medicine, Oslo University Hospital University of Oslo, Oslo, Norway.
J Epidemiol Community Health. 2012 Nov;66(11):1030-6. doi: 10.1136/jech-2011-200312. Epub 2012 Apr 7.
Previous studies, all of <20 years of follow-up, have suggested an association between lung function and the risk of fatal stroke. This study investigates the stability of this association in a cohort followed for 4 decades.
The Bergen Clinical Blood Pressure Survey was conducted in Norway in 1964-1971. The risk of fatal stroke associated with forced expiratory volume after one second (FEV(1)) was estimated with Cox proportional hazards regression, making progressive adjustment for potential confounders.
Of 5617 (84%) participants with recorded baseline FEV(1), 462 died from stroke over 152 786 subsequent person-years of follow-up according to mortality statistics of 2005; mean (SD) follow-up was 27 (12) years. An association between baseline FEV(1) (L) and fatal stroke was observed; HR=1.38 (95% CI 1.11 to 1.71) and HR=1.62 (95% CI 1.22 to 2.15) for men and women, respectively (adjusted for age and height). The findings were not explained by smoking, hypertension, diabetes, atherosclerosis, socioeconomic status, obstructive lung disease, physical inactivity, cholesterol or body mass index and persisted in subgroups of never-smokers, subgroups without respiratory symptoms and survivors of the first 20 years of follow-up. For male survivors with a valid FEV(1) at follow-up (1988-1990) (n=953), baseline FEV(1) (L) indicated a possible strong and independent association to the risk of fatal stroke after adjustments for individual changes in FEV(1) (ml/year) (HR 1.95 (95% CI 0.98 to 3.86)).
There is a consistent, independent and long-lasting association between lung function and fatal stroke, probably irrespective of changes during adult life.
此前的研究（随访时间均不足 20 年）提示，肺功能与致命性卒中风险之间存在关联。本研究旨在一项随访时间长达 40 年的队列研究中评估这种关联的稳定性。
1964 年至 1971 年，挪威开展了卑尔根临床血压研究。采用 Cox 比例风险回归模型，对 5617 名（84%）记录有基础一秒用力呼气容积（FEV1）的参与者，估计了与第一秒用力呼气容积（FEV1）相关的致命性卒中风险，同时对潜在混杂因素进行了逐步调整。
根据 2005 年的死亡率统计数据，在随后的 152 786 人年随访中，有 462 人死于卒中；中位（标准差）随访时间为 27（12）年。研究观察到基础 FEV1（L）与致命性卒中之间存在关联；男性和女性的 HR 分别为 1.38（95%CI 1.11 至 1.71）和 1.62（95%CI 1.22 至 2.15）（校正年龄和身高后）。这些发现不能用吸烟、高血压、糖尿病、动脉粥样硬化、社会经济地位、阻塞性肺病、身体活动不足、胆固醇或体重指数来解释，且在从不吸烟者亚组、无呼吸系统症状亚组和随访前 20 年生存者亚组中仍然存在。对于在随访时（1988 年至 1990 年）具有有效 FEV1 值的男性幸存者（n=953），校正 FEV1（ml/年）的个体变化后，基础 FEV1（L）表明与致命性卒中风险存在可能较强的独立关联（HR 1.95（95%CI 0.98 至 3.86））。
肺功能与致命性卒中之间存在一致、独立且持久的关联，可能与成年期的变化无关。
