Preserved Ratio Impaired Spirometry in Relationship to Cardiovascular Outcomes: A Large Prospective Cohort Study

Zheng，Jiazhen1,2,5; Zhou，Rui2; Zhang，Yingchai6; Su，Kelei8; Chen，Haowen2,10; Li，Furong3; Hukportie，Daniel Nyarko2; Niu，Fangbing9; Yiu，Kai Hang4,7; Wu，Xianbo2

2023-03-01

10.1016/j.chest.2022.11.003

CHEST   Impact Factor & Quartile

0012-3692

1931-3543

Background: Preserved ratio impaired spirometry (PRISm) findings are a heterogeneous condition characterized by a normal FEV to FVC ratio with underlying impairment of pulmonary function. Data relating to the association of baseline and trajectories of PRISm findings with diverse cardiovascular outcomes are sparse. Research Question: How do baseline and trajectories of PRISm findings impact subsequent cardiovascular events? Study Design and Methods: In the UK Biobank cohort study, we included participants free of cardiovascular disease (CVD) with spirometry (FEV and FVC values) at baseline (2006-2010). Participants with baseline spirometry and follow-up spirometry (2014-2020) were included in the lung function trajectory analysis. Cox proportional hazards multivariate regression was performed to evaluate the outcomes of major adverse cardiovascular events (MACEs), incident myocardial infarction (MI), stroke, heart failure (HF), and CVD mortality in association with lung function. Results: For baseline analysis (329,954 participants), the multivariate adjusted hazard ratios (HRs) for participants had PRISm findings (vs normal spirometry findings) were 1.26 (95% CI, 1.17-1.35) for MACE, 1.12 (95% CI, 1.01-1.25) for MI, 1.88 (95% CI, 1.72-2.05) for HF, 1.26 (95% CI, 1.13-1.40) for stroke, and 1.55 (95% CI, 1.37-1.76) for CVD mortality, respectively. A total of 22,781 participants underwent follow-up spirometry after an average of 8.9 years. Trajectory analysis showed that persistent PRISm findings (HR, 1.96; 95% CI, 1.24-3.09) and airflow obstruction (HR, 1.43; 95% CI, 1.00-2.04) was associated with a higher incidence of MACE vs consistently normal lung function. Compared with persistent PRISm findings, changing from PRISm to normal spirometry findings was associated with a lower incidence of MACE (HR, 0.42; 95% CI, 0.19-0.99). Interpretation: Individuals with baseline or persistent PRISm findings were at a higher risk of diverse cardiovascular outcomes even after adjusting for a wide range of confounding factors. However, individuals who transitioned from PRISm to normal findings showed a similar cardiovascular risk as those with normal lung function.

cardiovascular events epidemiology lung function PRISm risk

SCI

English

Others

Sanming Project of Medicine, Shenzhen, China[SZSM201911020] ; HKU-SZH Fund for Shenzhen Key Medical Discipline[SZXK2020081] ; National Natural Science Foundation of China[82173607] ; Guangdong Basic and Applied Basic Reuter Foundation[2021A1515011684] ; Open Project of the Guangdong Provincial Key Laboratory of Tropical Disease Research[2020B1212060042] ; Guangzhou Science and Technology Project[202102080597]

General & Internal Medicine ; Respiratory System

Critical Care Medicine ; Respiratory System

WOS:000962752000001

ELSEVIER

CLINICAL MEDICINE

2-s2.0-85147559984

Scopus

1.Bioscience and Biomedical Engineering Thrust,Systems Hub,The Hong Kong University of Science and Technology (Guangzhou),Guangdong,China
2.Department of Epidemiology,School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research),Southern Medical University,Guangzhou,China
3.School of Public Health and Emergency Management,Southern University of Science and Technology,Guangdong,China
4.Cardiology Division,Department of Medicine,The University of Hong Kong Shen Zhen Hospital,Shenzhen,Guangdong,China
5.Bioscience and Biomedical Engineering Thrust,Systems Hub,The Hong Kong University of Science and Technology,Clear Water Bay,Hong Kong SAR,China
6.Department of Medicine and Therapeutics,Prince of Wales Hospital,The Chinese University of Hong Kong,Sha Tin,New Territories,Hong Kong SAR,China
7.Cardiology Division,Department of Medicine,The University of Hong Kong,Queen Mary Hospital,Hong Kong Island,Hong Kong,Hong Kong
8.Department of Pulmonary and Critical Care Medicine,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Jiangsu,China
9.Department of Tuberculosis,Hebei Chest Hospital,Hebei,China
10.Institute of Applied Health Research,University of Birmingham,Birmingham,England,United Kingdom

Zheng，Jiazhen,Zhou，Rui,Zhang，Yingchai,et al. Preserved Ratio Impaired Spirometry in Relationship to Cardiovascular Outcomes: A Large Prospective Cohort Study[J]. CHEST,2023,163(3):610-623.

Zheng，Jiazhen.,Zhou，Rui.,Zhang，Yingchai.,Su，Kelei.,Chen，Haowen.,...&Wu，Xianbo.(2023).Preserved Ratio Impaired Spirometry in Relationship to Cardiovascular Outcomes: A Large Prospective Cohort Study.CHEST,163(3),610-623.

Zheng，Jiazhen,et al."Preserved Ratio Impaired Spirometry in Relationship to Cardiovascular Outcomes: A Large Prospective Cohort Study".CHEST 163.3(2023):610-623.