Lung Function in Young Adults and Risk of Cardiovascular Events Over 29 Years: The CARDIA Study

Abstract

Background Diminished peak lung function in young adulthood is a risk factor for future chronic obstructive pulmonary disease. The association between lung disease and cardiovascular disease later in life is well documented. Whether peak lung function measured in young adulthood is associated with risk of future cardiovascular events is unknown. Methods and Results CARDIA (The Coronary Artery Risk Development in Young Adults) study is a prospective, multicenter, community-based, longitudinal cohort study including 4761 participants aged 18 to 30 years with lung function testing we investigated the association between lung health in young adulthood and risk of subsequent cardiovascular events. We performed Cox proportional hazards regression to test the association between baseline and years 10 and 20 pulmonary function with incident cardiovascular events. Linear and logistic regression was performed to explore the associations of lung function with development of risk factors for cardiovascular disease as well as carotid intima-media thickness and coronary artery calcified plaque. At baseline, mean age (± SD ) was 24.9±3.6 years. Baseline forced expiratory volume in 1 second (hazard ratio) per -10-unit decrement in percent predicted forced expiratory volume in 1 second (hazard ratio, 1.18; 95% CI, 1.06-1.31 [ P=0.002]) and FVC per -10-unit decrement in percent predicted FVC (hazard ratio, 1.19; 95% CI, 1.06-1.33 [ P=0.003]) were associated with future cardiovascular events independent of traditional cardiovascular risk factors. Baseline lung function was associated with heart failure and cerebrovascular events but not coronary artery disease events. Conclusions Lung function in young adulthood is independently associated with cardiovascular events into middle age. This association appears to be driven by heart failure and cerebrovascular events rather than coronary heart disease. Clinical Trial Registration URL : https://www.clinicaltrials.gov . Unique identifier: NCT 00005130.

Keywords: cardiac disease; heart failure; lung; pulmonary; pulmonary heart disease.

Figure 1

Association of lung function at multiple time points with first fatal and nonfatal cardiovascular disease (CVD) events (A, B, and C report forced expiratory volume in 1 second [FEV₁], and D, E, and F report forced vital capacity [FVC]). A, Baseline (year 0) FEV ₁ is associated with increased risk of CVD events independent of year 0 covariates: age, race‐sex group, maximum education, diabetes mellitus, body mass index (BMI), total cholesterol, high‐density lipoprotein (HDL) cholesterol, systolic blood pressure (SBP), blood pressure medication use, and smoking status. B, With adjustment for year 10 covariates, year 10 FEV ₁ remains independently associated with first fatal and nonfatal CVD events. C, With adjustment for year 20 covariates, year 20 FEV ₁ no longer shows a statistically significant association with events. D, Baseline (year 0) FVC is associated with increased risk of CVD events independent of year 0 covariates: age, race‐sex group, maximum education, diabetes mellitus, BMI, total cholesterol, HDL cholesterol, SBP, blood pressure medication use, and smoking status. E, With adjustment for year 10 covariates, year 10 FVC remains independently associated with first fatal and nonfatal CVD events. F, With adjustment for year 20 covariates, year 20 FVC no longer shows a statistically significant association with events. Hazard ratios are expressed per −1 SD decrement in percent predicted FEV ₁ or FVC.