Introduction Although lung function measures are associated with cardiovascular disease (CVD), the added predictive values of these measures remain unclear. Methods From the UK Biobank, 308 415 participants free of CVD with spirometry parameters were included. The CVD outcomes included were defined by QRISK3, the American College of Cardiology/American Heart Association (ACC/AHA) and the European Systematic Coronary Risk Evaluation (SCORE) prediction models, respectively. Cox proportional hazard models were used to estimate the associations of lung function measures with CVD outcomes. The predictive capability was determined by the decision curve analyses. Results Over a median follow-up of 12.5 years, 21 885 QRISK3 events, 12 843 ACC/AHA events and 2987 SCORE events were recorded. The associations of spirometry parameters with CVD outcomes were L-shaped. Restrictive and obstructive impairments were associated with adjusted HRs of 1.84 (95% CI: 1.65 to 2.06) and 1.72 (95% CI: 1.55 to 1.90) for SCORE CVD, respectively, compared with normal spirometry. Similar associations were seen for QRISK3 CVD (restrictive vs normal, adjusted HR: 1.30, 95% CI: 1.25 to 1.36; obstructive vs normal, adjusted HR: 1.20, 95% CI: 1.15 to 1.25) and ACC/AHA CVD (restrictive vs normal, adjusted HR: 1.39, 95% CI: 1.31 to 1.47; obstructive vs normal, adjusted HR: 1.26, 95% CI: 1.19 to 1.33). Using models that integrated non-linear forced expiratory volume in 1 s led to additional 10-year net benefits per 100 000 persons of 25, 43 and 5 for QRISK3 CVD at the threshold of 10%, ACC/AHA CVD at 7.5% and SCORE CVD at 5.0%, respectively. Conclusion Clinicians could consider spirometry indicators in CVD risk assessment. Cost-effectiveness studies and clinical trials are needed to put new CVD risk assessment into practice. Data may be obtained from a third party and are not publicly available. Data set: Available from the UK Biobank on request (www.ukbiobank.ac.uk). Study protocol and statistical code: Available on request via email from the corresponding author.

中文翻译：

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肺功能测量对心血管风险的预测价值：一项大型前瞻性队列研究

简介 尽管肺功能测量与心血管疾病 (CVD) 相关，但这些测量的附加预测价值仍不清楚。方法 来自英国生物银行的 308 415 名无 CVD 且具有肺活量测定参数的参与者被纳入其中。所包括的 CVD 结果分别由 QRISK3、美国心脏病学会/美国心脏协会 (ACC/AHA) 和欧洲系统冠状动脉风险评估 (SCORE) 预测模型定义。 Cox 比例风险模型用于估计肺功能测量与 CVD 结果的关联。预测能力由决策曲线分析确定。结果 在中位随访 12.5 年期间，记录了 21 885 起 QRISK3 事件、12 843 起 ACC/AHA 事件和 2987 起 SCORE 事件。肺活量测定参数与 CVD 结果的关联呈 L 形。与正常肺活量测定相比，限制性和阻塞性损伤与 SCORE CVD 的调整后 HR 分别为 1.84（95% CI：1.65 至 2.06）和 1.72（95% CI：1.55 至 1.90）。 QRISK3 CVD（限制性与正常，调整后 HR：1.30，95% CI：1.25 至 1.36；阻塞性与正常，调整后 HR：1.20，95% CI：1.15 至 1.25）和 ACC/AHA CVD（限制性与正常正常，调整后 HR：1.39，95% CI：1.31 至 1.47；阻塞性与正常，调整后 HR：1.26，95% CI：1.19 至 1.33）。使用在 1 秒内整合非线性用力呼气量的模型，对于 QRISK3 CVD（阈值为 10%）、ACC/AHA CVD（阈值为 7.5%）和 SCORE，每 10 万人（25、43 和 5）获得额外的 10 年净效益CVD 分别为 5.0%。结论 临床医生可以在CVD风险评估中考虑肺活量测定指标。需要进行成本效益研究和临床试验，将新的 CVD 风险评估付诸实践。数据可能从第三方获得，并且不公开。数据集：可根据要求从英国生物银行获取 (www.ukbiobank.ac.uk)。研究方案和统计代码：可通过通讯作者的电子邮件索取。