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Rapid decline in lung function, measured by serial spirometry, was associated with a greater incidence of heart failure and other cardiovascular disease outcomes, according to new research.

Specifically, a rapid drop in forced expiratory volume in 1 second (FEV₁) was associated with a fourfold increased risk of incident heart failure during the first year of follow-up in a community-based cohort of more than 10,000 participants enrolled in the prospective Atherosclerosis Risk in Communities (ARIC) study.

Rapid decline in lung function measured by forced vital capacity (FVC) was associated with elevated heart failure risk throughout approximately 17 years of follow-up in the study online in the .

"Neither sex nor race significantly modified these associations," wrote Amil Shah, MD, of Brigham and Women's Hospital in Boston, and colleagues. "These findings demonstrate that deterioration in lung function is a predictor of incident cardiovascular disease, independent of smoking status and baseline lung function."

The researchers noted that while rapid lung function decline is a well-known predictor of incident chronic obstructive pulmonary disease and coronary disease mortality, the association with incident cardiovascular events is not well understood.

"Incipient or early heart failure may cause rapid deterioration in spirometric measures, and FEV₁ in particular, due to interstitial and alveolar edema and consequent airway compression. However, rapid lung function decline secondary to early and undiagnosed heart failure (reserve causality) would be expected to predict incident heart failure during short-term as opposed to long term follow-up," the team wrote.

Shah and co-authors hypothesized that declines in pulmonary function would be associated with an increase in risk for heart failure, stroke, coronary disease, and death over 2 decades of follow-up in a cohort of middle-aged individuals free of cardiovascular disease at baseline.

The analysis included 10,351 participants in the ARIC study who were free of prevalent cardiovascular disease. Rapid lung function decline was defined as the greatest quartile (n=2,585) of decline in either FEV₁ (>1.9% decline/year) or FVC (>2.1% decline/year) over 2.9±0.2 years.

The relationship between rapid decline in FEV₁ or FVC and subsequent incident heart failure, coronary heart disease (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 (NT-pro-BNP), and smoking.

The mean age of the participants was 54±6 years, 56% were women, and 81% were white. At 17±6 years of follow-up, heart failure occurred in 14% of participants, CHD in 11%, stroke in 6%, and the composite in 24%.

The analysis revealed that:

• Rapid decline in FEV₁ and in FVC were both associated with a heightened risk of incident heart failure (hazard ratio [HR]: 1.17; 95% CI, 1.04-1.33; P=0.010; and HR: 1.27; 95% CI, 1.12-1.44; P<0.001; respectively)
• Rapid decline in FEV₁ was most prognostic in the first year of follow-up (HR: 4.22, 95% CI: 1.34-13.26; P=0.01)
• Rapid decline in FEV₁ was also associated with incident stroke (HR: 1.25; 95% CI, 1.04-1.50; P=0.015)

"Rapid decline in both FEV1 and FVC was associated with a higher risk of incident heart failure, even after adjusting for potentially confounding cardiovascular risk factors, including smoking status and accounting for pack-years and NT-pro-BNP," the researchers wrote. "In addition, the association persisted after excluding participants with incident coronary heart disease, showing that incident coronary heart disease or myocardial infarction does not explain this association. We are not aware of other studies demonstrating a relationship between changes in lung function and heart failure risk."

In an , Daniel A. Duprez, MD, PhD, and David R. Jacobs, Jr, PhD, both of the University of Minnesota in Minneapolis, noted that spirometric lung function assessment remains rare outside the setting of lung disease diagnosis and follow-up.

They also pointed to their own Multi-Ethnic Study of Atherosclerosis, published in 2013, which measured small and large artery elasticity at baseline in a multiethnic population of people between the ages of 45 and 84, which was found to be associated with FVC and FEV1 measured 5 years later. The cross-sectional study showed that low lung function was associated with microvascular changes in the heart, retina, and kidneys, and that low lung function was also associated with impaired myocardial microvascular infusion.

"Greater collaboration is required between cardiologists and pulmonologists to better identify decline in lung function and early detection of cardiovascular disease," Duprez and Jacobs wrote. "This would facilitate managing these conditions to halt the progression of early disease and prevent overt cardiovascular disease. The resulting symptomatic and prognostic benefits outweigh those attainable by treating either condition alone."

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