Department of Clinical Sciences, Lund University, Malmö, Sweden
Vascular Department of Angiology, Skåne University Hospital, Malmo, Sweden.
BMJ Open Respir Res. 2021 Sep;8(1). doi: 10.1136/bmjresp-2021-001043.
Many of those who suffer from a first acute coronary event (CE) die suddenly during the day of the event, most of them die outside hospital. Poor lung function is a strong predictor of future cardiac events; however, it is unknown whether the pattern of lung function impairment differs for the prediction of sudden cardiac death (SCD) versus non-fatal CEs. We examined measures of lung function in relation to future SCD and non-fatal CE in a population-based study.
Baseline spirometry was assessed in 28 584 middle-aged subjects, without previous history of CE, from the Malmö Preventive Project. The cohort was followed prospectively for incidence of SCD (death on the day of a first CE, inside or outside hospital) or non-fatal CE (survived the first day). A modified version of the Lunn McNeil's competing risk method for Cox regression was used to run models for both SCD and non-fatal CE simultaneously.
A 1-SD reduction in forced expiratory volume in 1 s (FEV) was more strongly associated with SCD than non-fatal CE even after full adjustment (FEV: HR for SCD: 1.23 (1.15 to 1.31), HR for non-fatal CE 1.08 (1.04 to 1.13), p value for equal associations=0.002). Similar associations were found for forced vital capacity (FVC) but not FEV/FVC. The results remained significant even in life-long never smokers (FEV: HR for SCD: 1.34 (1.15 to 1.55), HR for non-fatal CE: 1.11 (1.02 to 1.21), p value for equal associations=0.038). Similar associations were seen when % predicted values of lung function measures were used.
Low FEV is associated with both SCD and non-fatal CE, but consistently more strongly associated with future SCD. Measurement with spirometry in early life could aid in the risk stratification of future SCD. The results support the use of spirometry for a global assessment of cardiovascular risk.
许多首次急性冠状动脉事件（CE）的患者在事件当天突然死亡，其中大多数在医院外死亡。肺功能差是未来心脏事件的强有力预测指标；然而，目前尚不清楚肺功能损害的模式是否因预测心源性猝死（SCD）与非致命性 CE 而有所不同。我们在一项基于人群的研究中研究了肺功能与未来 SCD 和非致命性 CE 的关系。
在没有先前 CE 病史的 28584 名中年受试者中，基线时进行了肺活量测定。该队列进行了前瞻性随访，以确定 SCD（首次 CE 当天在医院内或外死亡）或非致命性 CE（存活至第一天）的发生率。使用 Lunn McNeil 竞争风险 Cox 回归的修正版本同时运行 SCD 和非致命性 CE 的模型。
即使在充分调整后，1 秒用力呼气量（FEV）降低 1 个标准差与 SCD 的相关性也强于非致命性 CE（FEV：SCD 的 HR 为 1.23（1.15 至 1.31），非致命性 CE 的 HR 为 1.08（1.04 至 1.13），相等关联的 p 值=0.002）。对于用力肺活量（FVC）也发现了类似的关联，但 FEV/FVC 则不然。即使在终身从不吸烟者中，结果仍然显著（FEV：SCD 的 HR 为 1.34（1.15 至 1.55），非致命性 CE 的 HR 为 1.11（1.02 至 1.21），相等关联的 p 值=0.038）。当使用肺功能测量的预测值%时，也观察到类似的关联。
低 FEV 与 SCD 和非致命性 CE 均相关，但与未来 SCD 的相关性更强。在生命早期进行肺活量测定有助于对未来 SCD 的风险分层。结果支持使用肺活量测定法进行心血管风险的全面评估。
