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. 2024 Jul 16;79(8):770-777.
doi: 10.1136/thorax-2023-220485.

Lung function trajectories from school age to adulthood and their relationship with markers of cardiovascular disease risk

Raquel Granell #  1 , Sadia Haider #  2 , Matea Deliu  2 , Anhar Ullah  2 , Osama Mahmoud  3   4 , Sara Fontanella  2 , Lesley Lowe  5 , Angela Simpson  5 , James William Dodd  6   7 , Seyed Hasan Arshad  8 , Clare S Murray  9 , Graham Roberts  10   11 , Alun Hughes  12 , Chloe Park  12 , John W Holloway #  10 , Adnan Custovic #  2 ; STELAR/UNICORN investigators
Collaborators, Affiliations

Lung function trajectories from school age to adulthood and their relationship with markers of cardiovascular disease risk

Raquel Granell et al. Thorax. .

Abstract

Rationale: Lung function in early adulthood is associated with subsequent adverse health outcomes.

Objectives: To ascertain whether stable and reproducible lung function trajectories can be derived in different populations and investigate their association with objective measures of cardiovascular structure and function.

Methods: Using latent profile modelling, we studied three population-based birth cohorts with repeat spirometry data from childhood into early adulthood to identify trajectories of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC). We used multinomial logistic regression models to investigate early-life predictors of the derived trajectories. We then ascertained the extent of the association between the derived FEV1/FVC trajectories and blood pressure and echocardiographic markers of increased cardiovascular risk and stroke in ~3200 participants at age 24 years in one of our cohorts.

Results: We identified four FEV1/FVC trajectories with strikingly similar latent profiles across cohorts (pooled N=6377): above average (49.5%); average (38.3%); below average (10.6%); and persistently low (1.7%). Male sex, wheeze, asthma diagnosis/medication and allergic sensitisation were associated with trajectories with diminished lung function in all cohorts. We found evidence of an increase in cardiovascular risk markers ascertained by echocardiography (including left ventricular mass indexed to height and carotid intima-media thickness) with decreasing FEV1/FVC (with p values for the mean crude effects per-trajectory ranging from 0.10 to p<0.001). In this analysis, we considered trajectories as a pseudo-continuous variable; we confirmed the assumption of linearity in all the regression models.

Conclusions: Childhood lung function trajectories may serve as predictors in the development of not only future lung disease, but also the cardiovascular disease and multimorbidity in adulthood.

Keywords: Respiratory Measurement.

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Conflict of interest statement

Competing interests: RG, SH, MD, AU, OM, SF, LL, AS, CP, CSM and GR declare no conflicts of interest. AS has received research grants. JWD has received research and charity grants and declares pharmaceutical support for lectures and attending conferences/meetings. AH has received support from Research Institutions and declares an unpaid fiduciary role. JWH has received research grant and support for travel to congress. AC has received research grants, consulting fees, honoraria for lectures and declares unpaid fiduciary role.

Figures

Figure 1
Figure 1
Mean FEV1/FVC over time in the four trajectory classes. ALSPAC, Avon Longitudinal Study of Parents and Children; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; IOW, Isle of Wight; MAAS, Manchester Asthma and Allergy Study.
Figure 2
Figure 2
Distribution of partition-around-medoids (PAM) wheeze phenotypes (ETW, INT, LOW, NWZ, PEW) membership by FEV1/FVC assigned classes. ALSPAC, Avon Longitudinal Study of Parents and Children; ETW, early-transient; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; INT, intermittent; IOW, Isle of Wight; LOW, late-onset; MAAS, Manchester Asthma and Allergy Study; NWZ, never; PEW, persistent wheeze.
See this image and copyright information in PMC

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