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Abstract
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.
- Respiratory Measurement
Data availability statement
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.
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Data availability statement
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.
Footnotes
Contributors YaW conceived and designed the study. LHZ conducted the data analysis and interpreted the results assisted and supervised by HXY, YZ and YuW. LHZ drafted the manuscript. HXY, YZ, YuW, XZ, TL, QY and YaW critically revised the manuscript for important intellectual content. All authors approved the final version of the manuscript. The corresponding author attests that all the listed authors meet authorship criteria and that no others meeting the criteria have been omitted. YaW is the guarantor of the paper.
Funding This study was supported by the National Natural Science Foundation of China (No. 71910107004) and the Major Science and Technology Project of Public Health in Tianjin (No. 21ZXGWSY00090).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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