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Thorax 63:599-605 doi:10.1136/thx.2007.088112
  • Chronic obstructive pulmonary disease

Relationship between lung function impairment and incidence or recurrence of cardiovascular events in a middle-aged cohort

  1. A K Johnston1,
  2. D M Mannino1,
  3. G W Hagan2,
  4. K J Davis3,
  5. V A Kiri2
  1. 1
    Division of Pulmonary and Critical Care Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
  2. 2
    GlaxoSmithKline R&D, Greenford, UK
  3. 3
    GlaxoSmithKline Research and Development, Research Triangle Park, North Carolina, USA
  1. Dr D M Mannino, Division of Pulmonary and Critical Care Medicine, University of Kentucky Medical Center, 800 Rose Street, MN 614, Lexington, KY 40536; dmannino{at}uky.edu
  • Received 30 July 2007
  • Accepted 23 December 2007
  • Published Online First 1 February 2008

Abstract

Introduction: Lung function impairment may be a risk factor for cardiovascular disease (CVD) events.

Objective: To determine the relationship between the severity of airflow obstruction based on modified Global Initiative on Obstructive Lung Disease (GOLD) criteria and the prevalence and incidence or recurrence of CVD in a cohort of US adults, aged 45–64 years, from 1987 to 2001.

Methods: We analysed data from 14 681 adults using logistic regression to determine the cross sectional association between lung function impairment and prevalent CVD at baseline and Cox regression to examine the prospective association of lung function impairment at baseline with CVD over 15 years of follow-up. Models were adjusted for age, sex, race, smoking, comorbid hypertension and diabetes, cholesterol levels and fibrinogen level.

Results: At baseline, the crude prevalence of CVD was higher among subjects with GOLD 2 (OR 2.9, 95% CI 2.4 to 3.6) and GOLD 3 or 4 chronic obstructive pulmonary disease (COPD) (OR 3.0, 95% CI 2.0 to 4.5), compared with normal subjects. These relative risks were greatly reduced after adjusting for covariates (OR 1.4, 95% CI 1.1 to 1.8 for GOLD 2 and OR 1.3, 95% CI 0.8 to 2.1 for GOLD 3 or 4). Similarly, the association between COPD and risk of incident or recurrent CVD was much stronger in the unadjusted models (hazard ratio (HR) 2.4, 95% CI 2.1 to 2.7 for GOLD 2 and 2.9, 95% CI 2.2 to 3.9 for GOLD 3 or 4) than in the adjusted ones (HR 1.2, 95% CI 1.03 to 1.4 for GOLD 2 and 1.5, 95% CI 1.1 to 2.0 for GOLD 3 or 4).

Conclusion: We observed a crude association between lung function impairment and prevalent and incident or recurrent CVD that was greatly reduced after adjusting for covariates, including age, sex, race, smoking, comorbid hypertension and diabetes, cholesterol levels and fibrinogen level. These data suggest that this association may be, in part, mediated through established CVD risk factors included in our adjusted models.

Footnotes

  • Supplementary tables 1–3 are published online only at http://thorax.bmj.com/content/vol63/issue7

  • Funding: Funded by a research grant from GlaxoSmithKline.

  • Competing interests: GW, KD, and VK are employees of GlaxoSmithKline (GSK). DM has received research funding from GSK, Pfizer and Novartis and is a consultant to GSK, Pfizer, AstraZeneca, Boehringer-Ingleheim, Dey and Sepracor. AJ has no competing interests.

  • Ethics approval: Ethics approval was obtained.