Background Growing evidence suggests that compromised lung health may be linked to cardiovascular disease. However, little is known about its association with sudden cardiac death (SCD).
Objectives We aimed to assess the link between impaired lung function, airflow obstruction and risk of SCD by race and gender in four US communities.
Methods A total of 14 708 Atherosclerosis Risk in Communities (ARIC) study participants who underwent spirometry and were asked about lung health (1987–1989) were followed. The main outcome was physician-adjudicated SCD. Fine-Gray proportional subdistribution hazard models with Firth’s penalised partial likelihood correction were used to estimate the HRs.
Results Over a median follow-up of 25.4 years, 706 (4.8%) subjects experienced SCD. The incidence of SCD was inversely associated with FEV1 in each of the four race and gender groups and across all smoking status categories. After adjusting for multiple measured confounders, HRs of SCD comparing the lowest with the highest quintile of FEV1 were 2.62 (95% CI 1.62 to 4.26) for white males, 1.80 (95% CI 1.03 to 3.15) for white females, 2.07 (95% CI 1.05 to 4.11) for black males and 2.62 (95% CI 1.21 to 5.65) for black females. The above associations were consistently observed among the never smokers. Moderate to very severe airflow obstruction was associated with increased risk of SCD. Addition of FEV1 significantly improved the predictive power for SCD.
Conclusions Impaired lung function and airflow obstruction were associated with increased risk of SCD in general population. Additional research to elucidate the underlying mechanisms is warranted.
- respiratory measurement
- COPD epidemiology
- critical care
Data availability statement
All data relevant to the study are included in the article or uploaded as supplemental information.
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Y-JC, Z-GC and F-JY contributed equally.
Contributors S-HW and Y-JC conceived the overall idea and all authors designed the study. F-JY performed the statistical analyses, and Z-GC and Y-JC wrote the first draft of the manuscript. All revised the manuscript critically. All have given their final approval of the version to be published.
Funding The ARIC study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts. The study was also financially supported by the grants from National Natural Science Foundation of China (81600260, 81370285 and 81970206), Guangdong Natural Science Foundation (2016A030313210 and 2019A1515010269), Guangzhou City Science and Technology key Programme (201508020057), Guangdong Basic and Applied Basic Research Foundation (2021A1515010405), the project of Guangdong Province Science and Technology Plan (2017A020215174), the Fundamental Research Funds for the Central Universities in Sun Yat-Sen University (18ykpy08), the project of Kelin new star of the First Affiliated Hospital of Sun Yat-Sen University (Y50186) and the clinical research plan of the Eastern Hospital of the First Affiliated Hospital of Sun Yat-Sen University (2019007).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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