TY - JOUR
T1 - Association of Pulmonary Function With Late-Life Cardiac Function and Heart Failure Risk
T2 - The ARIC Study
AU - Ramalho, Sergio H.R.
AU - Claggett, Brian L.
AU - Washko, George R.
AU - Estepar, Raul San Jose
AU - Chang, Patricia P.
AU - Kitzman, Dalane W.
AU - Junior, Gerson Cipriano
AU - Solomon, Scott D.
AU - Skali, Hicham
AU - Shah, Amil M.
N1 - Publisher Copyright:
© 2022 The Authors.
PY - 2022/7/19
Y1 - 2022/7/19
N2 - BACKGROUND: Pulmonary and cardiac functions decline with age, but the associations of pulmonary dysfunction with cardiac function and heart failure (HF) risk in late life is not known. We aimed to determine the associations of percent predicted forced vital capacity (ppFVC) and the ratio of forced expired volume in 1 second (FEV1 ) to forced vital capacity (FVC; FEV1 /FVC) with cardiac function and incident HF with preserved or reduced ejection fraction in late life. METHODS AND RESULTS: Among 3854 HF-free participants in the ARIC (Atherosclerosis Risk in Communities) cohort study who underwent echocardiography and spirometry at the fifth study visit (2011–2013), associations of FEV1 /FVC and ppFVC with echocardiographic measures, cardiac biomarkers, and risk of HF, HF with preserved ejection fraction, and HF with reduced ejection fraction were assessed. Multivariable linear and Cox regression models adjusted for demographics, body mass index, coronary disease, atrial fibrillation, hypertension, and diabetes. Mean age was 75±5 years, 40% were men, 19% were Black, and 61% were ever smokers. Mean FEV1 /FVC was 72±8%, and ppFVC was 98±17%. In adjusted analyses, lower FEV1 /FVC and ppFVC were associated with higher NT-proBNP (N-terminal pro-B-type natriuretic peptide; both P<0.001) and pulmonary artery pressure (P<0.004). Lower ppFVC was also associated with higher left ventricular mass, left ventricular filling pressure, and high-sensitivity C-reactive protein (all P<0.01). Lower FEV1 /FVC was associated with a trend toward higher risk of incident HF with preserved ejection fraction (hazard ratio [HR] per 10-point decrease, 1.31; 95% CI, 0.98–1.74; P=0.07) and HF with reduced ejection fraction (HR per 10-point decrease, 1.24; 95% CI, 0.91–1.70; P=0.18), but these associations did not reach statistical significance. Lower ppFVC was associated with incident HF with preserved ejection fraction (HR per 10-unit de-crease, 1.21; 95% CI, 1.04–1.41; P=0.013) but not with HF with reduced ejection fraction (HR per 10-unit decrease, 0.90; 95% CI, 0.76–1.07; P=0.24). CONCLUSIONS: Subclinical reductions in FEV1 /FVC and ppFVC differentially associate with cardiac function and HF risk in late life.
AB - BACKGROUND: Pulmonary and cardiac functions decline with age, but the associations of pulmonary dysfunction with cardiac function and heart failure (HF) risk in late life is not known. We aimed to determine the associations of percent predicted forced vital capacity (ppFVC) and the ratio of forced expired volume in 1 second (FEV1 ) to forced vital capacity (FVC; FEV1 /FVC) with cardiac function and incident HF with preserved or reduced ejection fraction in late life. METHODS AND RESULTS: Among 3854 HF-free participants in the ARIC (Atherosclerosis Risk in Communities) cohort study who underwent echocardiography and spirometry at the fifth study visit (2011–2013), associations of FEV1 /FVC and ppFVC with echocardiographic measures, cardiac biomarkers, and risk of HF, HF with preserved ejection fraction, and HF with reduced ejection fraction were assessed. Multivariable linear and Cox regression models adjusted for demographics, body mass index, coronary disease, atrial fibrillation, hypertension, and diabetes. Mean age was 75±5 years, 40% were men, 19% were Black, and 61% were ever smokers. Mean FEV1 /FVC was 72±8%, and ppFVC was 98±17%. In adjusted analyses, lower FEV1 /FVC and ppFVC were associated with higher NT-proBNP (N-terminal pro-B-type natriuretic peptide; both P<0.001) and pulmonary artery pressure (P<0.004). Lower ppFVC was also associated with higher left ventricular mass, left ventricular filling pressure, and high-sensitivity C-reactive protein (all P<0.01). Lower FEV1 /FVC was associated with a trend toward higher risk of incident HF with preserved ejection fraction (hazard ratio [HR] per 10-point decrease, 1.31; 95% CI, 0.98–1.74; P=0.07) and HF with reduced ejection fraction (HR per 10-point decrease, 1.24; 95% CI, 0.91–1.70; P=0.18), but these associations did not reach statistical significance. Lower ppFVC was associated with incident HF with preserved ejection fraction (HR per 10-unit de-crease, 1.21; 95% CI, 1.04–1.41; P=0.013) but not with HF with reduced ejection fraction (HR per 10-unit decrease, 0.90; 95% CI, 0.76–1.07; P=0.24). CONCLUSIONS: Subclinical reductions in FEV1 /FVC and ppFVC differentially associate with cardiac function and HF risk in late life.
KW - cardiopulmonary
KW - elderly
KW - heart dysfunction
KW - lung function
KW - respiratory disease
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U2 - 10.1161/JAHA.121.023990
DO - 10.1161/JAHA.121.023990
M3 - Article
C2 - 35861819
AN - SCOPUS:85134568699
SN - 2047-9980
VL - 11
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 14
M1 - e023990
ER -