Lung function and onset of cardiometabolic diseases in the longitudinal Burden of Obstructive Lung Disease study

doi:10.1136/bmjresp-2024-002442

Multicenter Study

. 2025 Jan 19;12(1):e002442.

doi: 10.1136/bmjresp-2024-002442.

Lung function and onset of cardiometabolic diseases in the longitudinal Burden of Obstructive Lung Disease study

Christer Janson¹, James Potts², Andrei Malinovschi³, Dhiraj Agarwal⁴, Rana Ahmed⁵, Althea Aquart-Stewart⁶, Imed Harrabi⁷, Meriam Denguezli⁸, Graham Devereux⁹, Gregory E Erhabor¹⁰, Thorarinn Gislason¹¹, Rain Jogi¹², Sanjay K Juvekar¹³, Ben Knox-Brown², Parvaiz Koul¹⁴, Kevin Mortimer^{15

16}, Asaad Ahmed Nafees¹⁷, Rune Nielsen¹⁸, Padukudru Anand Mahesh¹⁹, Stefanni Nonna M Paraguas²⁰, Anders Ørskov Rotevatn²¹, Talant Sooronbaev^{22

23}, Peter G J Burney², Andre F S Amaral²; BOLD Collaborative Research Group

Collaborators, Affiliations

Collaborators

BOLD Collaborative Research Group:
Hasan Hafizi, Anila Aliko, Donika Bardhi, Holta Tafa, Natasha Thanasi, Arian Mezini, Alma Teferici, Dafina Todri, Jolanda Nikolla, Rezarta Kazasi, Hamid Hacene Cherkaski, Amira Bengrait, Tabarek Haddad, Ibtissem Zgaoula, Maamar Ghit, Abdelhamid Roubhia, Soumaya Boudra, Feryal Atoui, Randa Yakoubi, Rachid Benali, Abdelghani Bencheikh, Nadia Ait-Khaled, Christine Jenkins, Guy Marks, Tessa Bird, Paola Espinel, Kate Hardaker, Brett Toelle, Michael Studnicka, Torkil Dawes, Bernd Lamprecht, Lea Schirhofer, Akramul Islam, Syed Masud Ahmed, Shayla Islam, Qazi Shafayetul Islam, Mesbah Ul-Haque, Tridib Roy Chowdhury, Sukantha Kumar Chatterjee, Dulal Mia, Shyamal Chandra Das, Mizanur Rahman, Nazrul Islam, Shahaz Uddin, Nurul Islam, Luiza Khatun, Monira Parvin, Abdul Awal Khan, Maidul Islam, Herve Lawin, Arsene Kpangon, Karl Kpossou, Gildas Agodokpessi, Paul Ayelo, Benjamin Fayomi, Bertrand Mbatchou, Atongno Humphrey Ashu, Wan C Tan, Wen Wang, NanShan Zhong, Shengming Liu, Jiachun Lu, Pixin Ran, Dali Wang, Jin-Ping Zheng, Yumin Zhou, Rain Jogi, Hendrik Laja, Katrin Ulst, Vappu Zobel, Toomas-Julius Lill, Ayola Akim Adegnika, Tobias Welte, Isabelle Bodemann, Henning Geldmacher, Alexandra SchwedaLinow, Thorarinn Gislason, Bryndis Benedikdtsdottir, Kristin Jorundsdottir, Lovisa Gudmundsdottir, Sigrun Gudmundsdottir, Gunnar Gudmundsson, Mahesh Rao, Parvaiz A Koul, Sajjad Malik, Nissar A Hakim, Umar Hafiz Khan, Rohini Chowgule, Vasant Shetye, Jonelle Raphael, Rosel Almeda, Mahesh Tawde, Rafiq Tadvi, Sunil Katkar, Milind Kadam, Rupesh Dhanawade, Umesh Ghurup, Sanjay Juvekar, Siddhi Hirve, Somnath Sambhudas, Bharat Chaidhary, Meera Tambe, Savita Pingale, Arati Umap, Archana Umap, Nitin Shelar, Sampada Devchakke, Sharda Chaudhary, Suvarna Bondre, Savita Walke, Ashleshsa Gawhane, Anil Sapkal, Rupali Argade, Vijay Gaikwad, Sundeep Salvi, Bill Brashier, Jyoti Londhe, Sapna Madas, Althea Aquart-Stewart, Akosua Francia Aikman, Talant M Sooronbaev, Bermet M Estebesova, Meerim Akmatalieva, Saadat Usenbaeva, Jypara Kydyrova, Eliza Bostonova, Ulan Sheraliev, Nuridin Marajapov, Nurgul Toktogulova, Berik Emilov, Toktogul Azilova, Gulnara Beishekeeva, Nasyikat Dononbaeva, Aijamal Tabyshova, Kevin Mortimer, Wezzie Nyapigoti, Ernest Mwangoka, Mayamiko Kambwili, Martha Chipeta, Gloria Banda, Suzgo Mkandawire, Justice Banda, Li-Cher Loh, Abdul Rashid, Siti Sholehah, Mohamed C Benjelloun, Chakib Nejjari, Mohamed Elbiaze, Karima El Rhazi, Efm Wouters, G J Wesseling, Daniel Obaseki, Gregory Erhabor, Olayemi Awopeju, Olufemi Adewole, Amund Gulsvik, Tina Endresen, Lene Svendsen, Asaad A Nafees, Muhammad Irfan, Zafar Fatmi, Aysha Zahidie, Natasha Shaukat, Meesha Iqbal, Luisito F Idolor, Teresita S de Guia, Norberto A Francisco, Camilo C Roa, Fernando G Ayuyao, Cecil Z Tady, Daniel T Tan, Sylvia Banal-Yang, Vincent M Balanag, MariaTeresita N Reyes, Renato B Dantes, Renato B Dantes, Lourdes Amarillo, Lakan U Berratio, Lenora C Fernandez, Norberto A Francisco, Gerard S Garcia, Teresita S de Guia, Luisito F Idolor, Sullian S Naval, Thessa Reyes, Camilo C Roa, Flordeliza Sanchez, Leander P Simpao, Ewa Nizankowska-Mogilnicka, Jakub Frey, Rafal Harat, Filip Mejza, Pawel Nastalek, Andrzej Pajak, Wojciech Skucha, Andrzej Szczeklik, Magda Twardowska, Cristina Barbara, Fatima Rodrigues, Herminia Dias, Joao Cardoso, João Almeida, Maria Joao Matos, Paula Simão, Moutinho Santos, Reis Ferreira, MAl Ghobain, H Alorainy, E El-Hamad, M Al Hajjaj, A Hashi, R Dela, R Fanuncio, E Doloriel, I Marciano, L Safia, Eric Bateman, Anamika Jithoo, Desiree Adams, Edward Barnes, Jasper Freeman, Anton Hayes, Sipho Hlengwa, Christine Johannisen, Mariana Koopman, Innocentia Louw, Ina Ludick, Alta Olckers, Johanna Ryck, Janita Storbeck, Kirthi Gunasekera, Rajitha Wickremasinghe, Asma Elsony, Hana A Elsadig, Nada Bakery Osman, Bandar Salah Noory, Monjda Awad Mohamed, Hasab Alrasoul Akasha Ahmed Osman, Namarig Mohamed Elhassan, Abdel Mu'is El Zain, Marwa Mohamed Mohamaden, Suhaiba Khalifa, Mahmoud Elhadi, Mohand Hassan, Dalia Abdelmonam, Christer Janson, Inga Sif Olafsdottir, Katarina Nisser, Ulrike SpetzNystrom, Gunilla Hagg, GunMarie Lund, Terence Seemungal, Fallon Lutchmansingh, Liane Conyette, Imed Harrabi, Myriam Denguezli, Zouhair Tabka, Hager Daldoul, Zaki Boukheroufa, Firas Chouikha, Wahbi Belhaj Khalifa, Ali Kocabas, Attila Hancioglu, Ismail Hanta, Sedat Kuleci, Ahmet Sinan Turkyilmaz, Sema Umut, Turgay Unalan, Peter Gj Burney, Anamika Jithoo, Louisa Gnatiuc, Hadia Azar, Jaymini Patel, Caron Amor, James Potts, Michael Tumilty, Fiona McLean, Risha Dudhaiya, A Sonia Buist, Mary Ann McBurnie, William M Vollmer, Suzanne Gillespie, Sean Sullivan, Todd A Lee, Kevin B Weiss, Robert L Jensen, Robert Crapo, Paul Enright, David M Mannino, John Cain, Rebecca Copeland, Dana Hazen, Jennifer Methvin

Affiliations

¹ Department of Medical Sciences Respiratory Medicine, Uppsala Universitet, Uppsala, Sweden christer.janson@medsci.uu.se.
² National Heart and Lung Institute, Imperial College London, London, UK.
³ Medical Sciences, Uppsala University, Uppsala, Sweden.
⁴ KEM Hospital Pune Research Centre, Pune, Maharashtra, India.
⁵ The Epidemiological Laboratory, Khartoum, Sudan.
⁶ The University of the West Indies, Kingston, Jamaica.
⁷ Faculté de Médecine, Sousse, Tunisia.
⁸ Universite de Sousse Faculte de Medecine de Sousse, Sousse, Tunisia.
⁹ Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
¹⁰ Department of Medicine, Obafemi Awolowo University, Ife, Nigeria.
¹¹ Landspitali University Hospital, Reykjavik, Iceland.
¹² Lung Clinic, Tartu University Hospital, Tartu, Estonia.
¹³ Independent Consultant, Pune, Maharashtra, India.
¹⁴ Pulmonary Medicine, SKIMS, Srinagar, India.
¹⁵ University of Cambridge, Cambridge, UK.
¹⁶ Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
¹⁷ Community Health Sciences, Aga Khan University, Karachi, Pakistan.
¹⁸ University of Bergen, Bergen, Norway.
¹⁹ Respiratory Medicine, JSS Medical College and Hospital, Mysore, Karnataka, India.
²⁰ Philippine College of Chest Physicians, Manila, Philippines.
²¹ Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
²² Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan.
²³ Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja Ashu, Kyrgyzstan.

PMID: 39832891
PMCID: PMC11751964
DOI: 10.1136/bmjresp-2024-002442

Multicenter Study

Lung function and onset of cardiometabolic diseases in the longitudinal Burden of Obstructive Lung Disease study

Christer Janson et al. BMJ Open Respir Res. 2025.

. 2025 Jan 19;12(1):e002442.

doi: 10.1136/bmjresp-2024-002442.

Authors

Collaborators

BOLD Collaborative Research Group:
Hasan Hafizi, Anila Aliko, Donika Bardhi, Holta Tafa, Natasha Thanasi, Arian Mezini, Alma Teferici, Dafina Todri, Jolanda Nikolla, Rezarta Kazasi, Hamid Hacene Cherkaski, Amira Bengrait, Tabarek Haddad, Ibtissem Zgaoula, Maamar Ghit, Abdelhamid Roubhia, Soumaya Boudra, Feryal Atoui, Randa Yakoubi, Rachid Benali, Abdelghani Bencheikh, Nadia Ait-Khaled, Christine Jenkins, Guy Marks, Tessa Bird, Paola Espinel, Kate Hardaker, Brett Toelle, Michael Studnicka, Torkil Dawes, Bernd Lamprecht, Lea Schirhofer, Akramul Islam, Syed Masud Ahmed, Shayla Islam, Qazi Shafayetul Islam, Mesbah Ul-Haque, Tridib Roy Chowdhury, Sukantha Kumar Chatterjee, Dulal Mia, Shyamal Chandra Das, Mizanur Rahman, Nazrul Islam, Shahaz Uddin, Nurul Islam, Luiza Khatun, Monira Parvin, Abdul Awal Khan, Maidul Islam, Herve Lawin, Arsene Kpangon, Karl Kpossou, Gildas Agodokpessi, Paul Ayelo, Benjamin Fayomi, Bertrand Mbatchou, Atongno Humphrey Ashu, Wan C Tan, Wen Wang, NanShan Zhong, Shengming Liu, Jiachun Lu, Pixin Ran, Dali Wang, Jin-Ping Zheng, Yumin Zhou, Rain Jogi, Hendrik Laja, Katrin Ulst, Vappu Zobel, Toomas-Julius Lill, Ayola Akim Adegnika, Tobias Welte, Isabelle Bodemann, Henning Geldmacher, Alexandra SchwedaLinow, Thorarinn Gislason, Bryndis Benedikdtsdottir, Kristin Jorundsdottir, Lovisa Gudmundsdottir, Sigrun Gudmundsdottir, Gunnar Gudmundsson, Mahesh Rao, Parvaiz A Koul, Sajjad Malik, Nissar A Hakim, Umar Hafiz Khan, Rohini Chowgule, Vasant Shetye, Jonelle Raphael, Rosel Almeda, Mahesh Tawde, Rafiq Tadvi, Sunil Katkar, Milind Kadam, Rupesh Dhanawade, Umesh Ghurup, Sanjay Juvekar, Siddhi Hirve, Somnath Sambhudas, Bharat Chaidhary, Meera Tambe, Savita Pingale, Arati Umap, Archana Umap, Nitin Shelar, Sampada Devchakke, Sharda Chaudhary, Suvarna Bondre, Savita Walke, Ashleshsa Gawhane, Anil Sapkal, Rupali Argade, Vijay Gaikwad, Sundeep Salvi, Bill Brashier, Jyoti Londhe, Sapna Madas, Althea Aquart-Stewart, Akosua Francia Aikman, Talant M Sooronbaev, Bermet M Estebesova, Meerim Akmatalieva, Saadat Usenbaeva, Jypara Kydyrova, Eliza Bostonova, Ulan Sheraliev, Nuridin Marajapov, Nurgul Toktogulova, Berik Emilov, Toktogul Azilova, Gulnara Beishekeeva, Nasyikat Dononbaeva, Aijamal Tabyshova, Kevin Mortimer, Wezzie Nyapigoti, Ernest Mwangoka, Mayamiko Kambwili, Martha Chipeta, Gloria Banda, Suzgo Mkandawire, Justice Banda, Li-Cher Loh, Abdul Rashid, Siti Sholehah, Mohamed C Benjelloun, Chakib Nejjari, Mohamed Elbiaze, Karima El Rhazi, Efm Wouters, G J Wesseling, Daniel Obaseki, Gregory Erhabor, Olayemi Awopeju, Olufemi Adewole, Amund Gulsvik, Tina Endresen, Lene Svendsen, Asaad A Nafees, Muhammad Irfan, Zafar Fatmi, Aysha Zahidie, Natasha Shaukat, Meesha Iqbal, Luisito F Idolor, Teresita S de Guia, Norberto A Francisco, Camilo C Roa, Fernando G Ayuyao, Cecil Z Tady, Daniel T Tan, Sylvia Banal-Yang, Vincent M Balanag, MariaTeresita N Reyes, Renato B Dantes, Renato B Dantes, Lourdes Amarillo, Lakan U Berratio, Lenora C Fernandez, Norberto A Francisco, Gerard S Garcia, Teresita S de Guia, Luisito F Idolor, Sullian S Naval, Thessa Reyes, Camilo C Roa, Flordeliza Sanchez, Leander P Simpao, Ewa Nizankowska-Mogilnicka, Jakub Frey, Rafal Harat, Filip Mejza, Pawel Nastalek, Andrzej Pajak, Wojciech Skucha, Andrzej Szczeklik, Magda Twardowska, Cristina Barbara, Fatima Rodrigues, Herminia Dias, Joao Cardoso, João Almeida, Maria Joao Matos, Paula Simão, Moutinho Santos, Reis Ferreira, MAl Ghobain, H Alorainy, E El-Hamad, M Al Hajjaj, A Hashi, R Dela, R Fanuncio, E Doloriel, I Marciano, L Safia, Eric Bateman, Anamika Jithoo, Desiree Adams, Edward Barnes, Jasper Freeman, Anton Hayes, Sipho Hlengwa, Christine Johannisen, Mariana Koopman, Innocentia Louw, Ina Ludick, Alta Olckers, Johanna Ryck, Janita Storbeck, Kirthi Gunasekera, Rajitha Wickremasinghe, Asma Elsony, Hana A Elsadig, Nada Bakery Osman, Bandar Salah Noory, Monjda Awad Mohamed, Hasab Alrasoul Akasha Ahmed Osman, Namarig Mohamed Elhassan, Abdel Mu'is El Zain, Marwa Mohamed Mohamaden, Suhaiba Khalifa, Mahmoud Elhadi, Mohand Hassan, Dalia Abdelmonam, Christer Janson, Inga Sif Olafsdottir, Katarina Nisser, Ulrike SpetzNystrom, Gunilla Hagg, GunMarie Lund, Terence Seemungal, Fallon Lutchmansingh, Liane Conyette, Imed Harrabi, Myriam Denguezli, Zouhair Tabka, Hager Daldoul, Zaki Boukheroufa, Firas Chouikha, Wahbi Belhaj Khalifa, Ali Kocabas, Attila Hancioglu, Ismail Hanta, Sedat Kuleci, Ahmet Sinan Turkyilmaz, Sema Umut, Turgay Unalan, Peter Gj Burney, Anamika Jithoo, Louisa Gnatiuc, Hadia Azar, Jaymini Patel, Caron Amor, James Potts, Michael Tumilty, Fiona McLean, Risha Dudhaiya, A Sonia Buist, Mary Ann McBurnie, William M Vollmer, Suzanne Gillespie, Sean Sullivan, Todd A Lee, Kevin B Weiss, Robert L Jensen, Robert Crapo, Paul Enright, David M Mannino, John Cain, Rebecca Copeland, Dana Hazen, Jennifer Methvin

Affiliations

¹ Department of Medical Sciences Respiratory Medicine, Uppsala Universitet, Uppsala, Sweden christer.janson@medsci.uu.se.
² National Heart and Lung Institute, Imperial College London, London, UK.
³ Medical Sciences, Uppsala University, Uppsala, Sweden.
⁴ KEM Hospital Pune Research Centre, Pune, Maharashtra, India.
⁵ The Epidemiological Laboratory, Khartoum, Sudan.
⁶ The University of the West Indies, Kingston, Jamaica.
⁷ Faculté de Médecine, Sousse, Tunisia.
⁸ Universite de Sousse Faculte de Medecine de Sousse, Sousse, Tunisia.
⁹ Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
¹⁰ Department of Medicine, Obafemi Awolowo University, Ife, Nigeria.
¹¹ Landspitali University Hospital, Reykjavik, Iceland.
¹² Lung Clinic, Tartu University Hospital, Tartu, Estonia.
¹³ Independent Consultant, Pune, Maharashtra, India.
¹⁴ Pulmonary Medicine, SKIMS, Srinagar, India.
¹⁵ University of Cambridge, Cambridge, UK.
¹⁶ Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
¹⁷ Community Health Sciences, Aga Khan University, Karachi, Pakistan.
¹⁸ University of Bergen, Bergen, Norway.
¹⁹ Respiratory Medicine, JSS Medical College and Hospital, Mysore, Karnataka, India.
²⁰ Philippine College of Chest Physicians, Manila, Philippines.
²¹ Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
²² Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan.
²³ Kyrgyz-Swiss High Altitude Clinic and Medical Research Center, Tuja Ashu, Kyrgyzstan.

PMID: 39832891
PMCID: PMC11751964
DOI: 10.1136/bmjresp-2024-002442

Abstract

Introduction: Previous population-based studies, mainly from high-income countries, have shown that a higher forced vital capacity (FVC) is associated with a lower risk of developing cardiometabolic diseases. The aim of this study was to assess the longitudinal association between spirometry measures and the onset of cardiometabolic diseases across sites in low-income, middle-income and high-income countries.

Methods: The study population comprised 5916 individuals from 15 countries participating in the Burden of Obstructive Lung Disease baseline and follow-up assessments. Postbronchodilator forced expiratory volume in 1 s (FEV1), FVC and FEV1/FVC were measured at baseline. Participants who reported having doctor-diagnosed hypertension, diabetes, heart disease and stroke at follow-up but not at baseline were considered new cases of these diseases. The association between lung function and the onset of participant-reported cardiometabolic diseases was assessed in each site using regression models, and estimates were combined using random effects meta-analysis. Models were adjusted for sex, age, smoking, body mass index and educational level.

Results: Participants with greater per cent predicted FVC were less likely to have new-onset diabetes (OR per 10%=0.91, 95% CI 0.84 to 0.99), heart disease (OR per 10%=0.86, 95% CI 0.80 to 0.92) and stroke (OR per 10%=0.81, 95% CI 0.73 to 0.89) during the follow-up period (mean±SD 9.5±3.6 years). A greater percentage of FEV₁ was associated with a lower risk of onset of heart disease and stroke. No significant association was found between FEV₁/FVC and onset of reported cardiometabolic diseases, except for a higher risk of diabetes (OR per 10%=1.21, 95% CI 1.08 to 1.35) in participants with higher FEV₁/FVC.

Conclusions: The findings of this study suggest that a low FVC is more important than a low FEV₁/FVC as a risk factor for developing cardiometabolic diseases. The value of including FVC in risk score models to improve their precision in predicting the onset of cardiometabolic diseases should be explored.

Keywords: COPD epidemiology; Clinical Epidemiology; Lung Physiology.

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Conflict of interest statement

Competing interests: RN declares support from Astra Zenenca related to and the Norwegian Respiratory Society not related to the manuscript. AØR declares support from Boehringer Ingelheim and the Endowment of Timber Merchant A. Delphin and Wife unrelated to the manuscript. PGJB declares support from the Wellcome Trust related to the manuscript. AFSA declares support from the Colt Foundation not related to the manuscript. None of the other authors declare any conflicts of interest.

Figures

**Figure 1. Study population of the Burden of Obstructive Lung Disease (BOLD) follow-up study.**

Figure 2. Association between forced vital capacity expressed as per cent of predicted and onset of diabetes, heart disease and stroke. Adjusted OR* (95% CI) for 10 units change. The association was assessed in each site and combined by random effects meta-analyses. I² values of 0%, 25%, 50% and 75% were considered no, low, moderate and high heterogeneity. *Adjusted for age, sex, smoke history, BMI and educational level baseline. BMI, body mass index.

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Fibular length and vital capacity in the multinational Burden of Obstructive Lung Disease follow-up study.
Burney PGJ, Nguyen T, Agarwal D, Janson C, Nielsen R, Mahesh PA, Jögi R, Erhabor G, Denguezli M, El Rhazi K, Potts J, Nafees AA, Koul P, Paraguas SN, Amaral AFS; Burden of Obstructive Lung Disease collaborators. Burney PGJ, et al. Eur Respir J. 2025 Jul 24;66(1):2500690. doi: 10.1183/13993003.00690-2025. Print 2025 Jul. Eur Respir J. 2025. PMID: 40571322 Free PMC article.

References

1. Ställberg B, Janson C, Larsson K, et al. Real-world retrospective cohort study ARCTIC shows burden of comorbidities in Swedish COPD versus non-COPD patients. NPJ Prim Care Respir Med. 2018;28:33. doi: 10.1038/s41533-018-0101-y. - DOI - PMC - PubMed
1. Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380:37–43. doi: 10.1016/S0140-6736(12)60240-2. - DOI - PubMed
1. Triest FJJ, Studnicka M, Franssen FME, et al. Airflow Obstruction and Cardio-metabolic Comorbidities. COPD. 2019;16:109–17. doi: 10.1080/15412555.2019.1614550. - DOI - PMC - PubMed
1. Kulbacka-Ortiz K, Triest FJJ, Franssen FME, et al. Restricted spirometry and cardiometabolic comorbidities: results from the international population based BOLD study. Respir Res. 2022;23:34. doi: 10.1186/s12931-022-01939-5. - DOI - PMC - PubMed
1. Margretardottir OB, Thorleifsson SJ, Gudmundsson G, et al. Hypertension, systemic inflammation and body weight in relation to lung function impairment-an epidemiological study. COPD. 2009;6:250–5. doi: 10.1080/15412550903049157. - DOI - PMC - PubMed

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[1] Ställberg B, Janson C, Larsson K, et al. Real-world retrospective cohort study ARCTIC shows burden of comorbidities in Swedish COPD versus non-COPD patients. NPJ Prim Care Respir Med. 2018;28:33. doi: 10.1038/s41533-018-0101-y. - DOI - PMC - PubMed

[2] Ställberg B, Janson C, Larsson K, et al. Real-world retrospective cohort study ARCTIC shows burden of comorbidities in Swedish COPD versus non-COPD patients. NPJ Prim Care Respir Med. 2018;28:33. doi: 10.1038/s41533-018-0101-y. - DOI - PMC - PubMed

[3] Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380:37–43. doi: 10.1016/S0140-6736(12)60240-2. - DOI - PubMed

[4] Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380:37–43. doi: 10.1016/S0140-6736(12)60240-2. - DOI - PubMed

[5] Triest FJJ, Studnicka M, Franssen FME, et al. Airflow Obstruction and Cardio-metabolic Comorbidities. COPD. 2019;16:109–17. doi: 10.1080/15412555.2019.1614550. - DOI - PMC - PubMed

[6] Triest FJJ, Studnicka M, Franssen FME, et al. Airflow Obstruction and Cardio-metabolic Comorbidities. COPD. 2019;16:109–17. doi: 10.1080/15412555.2019.1614550. - DOI - PMC - PubMed

[7] Kulbacka-Ortiz K, Triest FJJ, Franssen FME, et al. Restricted spirometry and cardiometabolic comorbidities: results from the international population based BOLD study. Respir Res. 2022;23:34. doi: 10.1186/s12931-022-01939-5. - DOI - PMC - PubMed

[8] Kulbacka-Ortiz K, Triest FJJ, Franssen FME, et al. Restricted spirometry and cardiometabolic comorbidities: results from the international population based BOLD study. Respir Res. 2022;23:34. doi: 10.1186/s12931-022-01939-5. - DOI - PMC - PubMed

[9] Margretardottir OB, Thorleifsson SJ, Gudmundsson G, et al. Hypertension, systemic inflammation and body weight in relation to lung function impairment-an epidemiological study. COPD. 2009;6:250–5. doi: 10.1080/15412550903049157. - DOI - PMC - PubMed

[10] Margretardottir OB, Thorleifsson SJ, Gudmundsson G, et al. Hypertension, systemic inflammation and body weight in relation to lung function impairment-an epidemiological study. COPD. 2009;6:250–5. doi: 10.1080/15412550903049157. - DOI - PMC - PubMed

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Lung function and onset of cardiometabolic diseases in the longitudinal Burden of Obstructive Lung Disease study

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Lung function and onset of cardiometabolic diseases in the longitudinal Burden of Obstructive Lung Disease study

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