Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Internal Medicine, Federal University of Acre, Rio Branco, Acre, Brazil.
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Internal Medicine, University of Campinas, Campinas, Brazil.
J Am Coll Cardiol. 2018 Sep 4;72(10):1109-1122. doi: 10.1016/j.jacc.2018.06.049.
Pulmonary dysfunction predicts incident cardiovascular disease (CVD).
The purpose of this study was to evaluate whether longitudinal decline in lung function is associated with incident heart failure (HF), coronary heart disease (CHD), and stroke.
Among 10,351 participants in the ARIC (Atherosclerosis Risk In Communities) study free of CVD, rapid lung function decline was defined as the greatest quartile (n = 2,585) of decline in either forced expiratory volume in 1 s (FEV) (>1.9% decline/year) or forced vital capacity (FVC) (>2.1% decline/year) over 2.9 ± 0.2 years. The relationship between rapid decline in FEV or FVC and subsequent incident HF, CHD, stroke, or a composite of these was assessed using multivariable Cox regression adjusting for the baseline spirometry value, demographics, height, body mass index, heart rate, diabetes, hypertension, low-density lipoprotein, use of lipid-lowering medication, N-terminal fragment of prohormone for B-type natriuretic peptide, and smoking.
The mean age was 54 ± 6 years, 56% were women, and 81% were white. At 17 ± 6 years of follow-up, HF occurred in 14%, CHD 11%, stroke 6%, and the composite in 24%. Rapid decline in FEV and in FVC were both associated with a heightened risk of incident HF (hazard ratio [HR]: 1.17; 95% confidence interval [CI]: 1.04 to 1.33; p = 0.010; and HR: 1.27; 95% CI: 1.12 to 1.44; p < 0.001; respectively), with rapid decline in FEV most prognostic in the first year of follow-up (HR: 4.22; 95% CI: 1.34 to 13.26; p = 0.01). Rapid decline in FEV was also associated with incident stroke (HR: 1.25; 95% CI: 1.04 to 1.50; p = 0.015).
A rapid decline in lung function, assessed by serial spirometry, is associated with a higher incidence of subsequent CVD, particularly incident HF.
肺功能障碍可预测心血管疾病（CVD）的发生。
本研究旨在评估肺功能的纵向下降是否与心力衰竭（HF）、冠心病（CHD）和中风的发生有关。
在 ARIC（社区动脉粥样硬化风险）研究的 10351 名无 CVD 的参与者中，快速肺功能下降定义为用力呼气量 1 秒（FEV）（>1.9%/年）或用力肺活量（FVC）（>2.1%/年）下降幅度最大的四分位数（n=2585）在 2.9±0.2 年内。使用多变量 Cox 回归评估 FEV 或 FVC 快速下降与随后发生的 HF、CHD、中风或这些疾病的综合事件之间的关系，调整了基线肺活量测定值、人口统计学、身高、体重指数、心率、糖尿病、高血压、低密度脂蛋白、降脂药物的使用、B 型利钠肽前体 N 端片段和吸烟。
平均年龄为 54±6 岁，56%为女性，81%为白人。在 17±6 年的随访中，发生 HF 14%、CHD 11%、中风 6%和复合事件 24%。FEV 和 FVC 的快速下降均与 HF 发生的风险增加相关（风险比[HR]：1.17；95%置信区间[CI]：1.04 至 1.33；p=0.010；和 HR：1.27；95%CI：1.12 至 1.44；p<0.001；分别），FEV 的快速下降在随访的第一年最具预测性（HR：4.22；95%CI：1.34 至 13.26；p=0.01）。FEV 的快速下降也与中风的发生有关（HR：1.25；95%CI：1.04 至 1.50；p=0.015）。
通过连续肺活量测定法评估的肺功能快速下降与随后发生的 CVD 发生率升高相关，尤其是 HF 的发生率。
