Airflow obstruction, lung function, and risk of incident heart failure: the Atherosclerosis Risk in Communities (ARIC) study

Abstract

Aims: We examined the relationship between forced expiratory volume in 1 s (FEV(1)), airflow obstruction, and incident heart failure (HF) in black and white, middle-aged men and women in four US communities.

Methods and results: Lung volumes by standardized spirometry and information on covariates were collected on 15 792 Atherosclerosis Risk in Communities (ARIC) cohort participants in 1987-89. Incident HF was ascertained from hospital records and death certificates up to 2005 in 13 660 eligible participants. Over an average follow-up of 14.9 years, 1369 (10%) participants developed new-onset HF. The age- and height-adjusted hazard ratios (HRs) for HF increased monotonically over descending quartiles of FEV(1) for both genders, race groups, and smoking status. After multivariable adjustment for traditional cardiovascular risk factors and height, the HRs [95% confidence intervals (CIs)] of HF comparing the lowest with the highest quartile of FEV(1) were 3.91 (2.40-6.35) for white women, 3.03 (2.12-4.33) for white men, 2.11 (1.33-3.34) for black women, and 2.23 (1.37-3.59) for black men. The association weakened but remained statistically significant after additional adjustment for systemic markers of inflammation. The multivariable adjusted incidence of HF was higher in those with FEV(1)/forced vital capacity <70% vs. ≥70%: HR 1.44 (95% CI 1.20-1.74) among men and 1.40 (1.13-1.72) among women. A consistent and positive association with HF was seen for self-reported diagnosis of emphysema and chronic obstructive pulmonary disease, but not for asthma.

Conclusions: In this large population-based cohort with long-term follow-up, low FEV(1) and an obstructive respiratory disease were strongly and independently associated with the risk of incident HF.

Figure 1

Estimated rate of new-onset heart failure (HF) per 1000 person years among black and white cohort members during an average study follow-up of 14.9 years by gender- and race-specific quartiles of forced expiratory volume in 1 s (FEV₁). The estimated rates are adjusted for age, height, and height × height. The estimated rates shown are for an individual 55 years of age, and 5.5 feet in height. Data are from the Atherosclerosis Risk in Communities (ARIC) study baseline examination (1987–89) in a subsample without prevalent HF and not missing information on important covariates, followed up to 31 December 2004. p-y, person years.

Figure 2

Estimated hazard ratio [95% confidence intervals (CI)] of incident heart failure for the quartiles of forced expiratory volume in 1 s (FEV₁) for each gender and race, adjusted for age, smoking, height, and height × height. The y-axis is plotted on a log scale with base 2. Data are from the Atherosclerosis Risk in Communities (ARIC) study baseline examination (1987–89) in a subsample without prevalent HF and not missing information on important covariates, followed up to 31 December 2004.

Figure 3

Multivariable adjusted cumulative-events estimates for incident heart failure by quartiles of forced expiratory volume in 1 s, i.e. Q1–Q4. Adjusted for age, gender, race, height, height × height, prevalent chronic heart disease, diabetes, hypertension, cigarette smoking status, cigarette-years of smoking, LDL-cholesterol, HDL-cholesterol, and body mass index. The curves are statistically not similar, using log rank test (P < 0.001). Data are from the Atherosclerosis Risk in Communities (ARIC) study baseline examination (1987–89) in a subsample without prevalent HF and not missing information on important covariates, followed up to 31 December 2004.