Aims: The aim is to evaluate associations of lung function impairment with risk of incident heart failure (HF). Methods and results: Data were pooled across eight US population-based cohorts that enrolled participants from 1987 to 2004. Participants with self-reported baseline cardiovascular disease were excluded. Spirometry was used to define obstructive [forced expiratory volume in 1 <FOR VERIFICATION>s/forced vital capacity (FEV1/FVC) <0.70] or restrictive (FEV1/FVC ≥0.70, FVC <80%) lung physiology. The incident HF was defined as hospitalization or death caused by HF. In a sub-set, HF events were sub-classified as HF with reduced ejection fraction (HFrEF; EF <50%) or preserved EF (HFpEF; EF ≥50%). The Fine-Gray proportional sub-distribution hazards models were adjusted for sociodemographic factors, smoking, and cardiovascular risk factors. In models of incident HF sub-types, HFrEF, HFpEF, and non-HF mortality were treated as competing risks. Among 31 677 adults, there were 3344 incident HF events over a median follow-up of 21.0 years. Of 2066 classifiable HF events, 1030 were classified as HFrEF and 1036 as HFpEF. Obstructive [adjusted hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.07-1.27] and restrictive physiology (adjusted HR 1.43, 95% CI 1.27-1.62) were associated with incident HF. Obstructive and restrictive ventilatory defects were associated with HFpEF but not HFrEF. The magnitude of the association between restrictive physiology and HFpEF was similar to associations with hypertension, diabetes, and smoking. Conclusion: Lung function impairment was associated with increased risk of incident HF, and particularly incident HFpEF, independent of and to a similar extent as major known cardiovascular risk factors.
Bibliographical noteFunding Information:
Conflict of interest The authors declare there are no conflicts of interest, beyond grant funding by the National Institutes of Health, with the following exceptions. A.S. receives funding from Novartis and Philips Ultrasound, for which he serves on an Advisory Board. L.S. participates on data safety monitoring boards from clinical trials by TORAY/Covance and Clinipace/Puretech. P.A.C. is a Field Advisory Board Member for Cochrane Nutrition. R.K. receives consulting fees and/or honoraria from CVS Health, AstraZeneca, GlaxoSmithKline, and Omron. S.P.B. receives royalties or licenses from Springer Humana; consulting fees from Boehringer Ingelheim, Sanovi/Regeneron, and Sunovion; payment or honoraria from GlaxoSmithKline; and holds stock or stock options from Vigor Medical Systems. At the time of manuscript resubmission, J.S. was employed by Vertex Pharmaceuticals; however, his participation in this project pre-dated and is independent of his employment at Vertex. S.J.S. has received research grants from Actelion, AstraZeneca, Corvia, Novartis, and Pfizer, and consulting fees from Abbott, Actelion, AstraZeneca, Amgen, Aria CV, Axon Therapies, Bayer, Boehringer-Ingelheim, Boston Scientific, Bristol-Myers Squibb, Cardiora, Coridea, CVRx, Cyclerion, Cytokinetics, Edwards Lifesciences, Eidos, Eisai, Imara, Impulse Dynamics, Intellia, Ionis, Ironwood, Lilly, Merck, MyoKardia, Novartis, Novo Nordisk, Pfizer, Prothena, Regeneron, Rivus, Sanofi, Shifamed, Tenax, Tenaya, and United Therapeutics.
This work was supported by The National Heart, Lung, and Blood Institute Pooled Cohorts Study that has been funded with federal funds from the National Heart, Lung, and Blood Institute and National Institutes of Health (R21-HL121457, R21-HL-129924, and K23-HL-130627). Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, and Department of Health and Human Services (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I). The authors thank the staff and participants of the ARIC study for their important contributions. Funding for laboratory testing and biospecimen collection at ARIC Visit 6 was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (R01DK089174). The authors thank the staff and participants of the ARIC study for their important contributions. The CARDIA (Coronary Artery Risk Development in Young Adults) Study: CARDIA is supported by contracts HHSN268201800003I, HHSN268201800004I, HHSN268201800005I, HHSN268201800006I, and HHSN268201800007I from the National Heart, Lung, and Blood Institute. CARDIA is also partially supported by the Intramural Research Program of the National Institute on Aging and an intra-agency agreement between National Institute on Aging and the National Heart, Lung, and Blood Institute (AG0005), as well as a National Heart, Lung, and Blood Institute grant (R01 HL122477 to R.K.). This manuscript has been reviewed by CARDIA for scientific content. Cardiovascular Health Study has been funded in whole or in part by contracts (HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, and N01HC85086) and grants (U01HL080295 and U01HL130114) from the National Heart, Lung, and Blood Institute, as well as grants (R01-HL093081 and R01-HL077612) with additional contribution from the National Institute of Neurological Disorders and Stroke. Additional support was provided by the National Institute on Aging (R01AG023629). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org. The FHS (Framingham Heart Study): From the Framingham Heart Study of the National Heart, Lung, and Blood Institute of the National Institutes of Health and Boston University School of Medicine. This work was supported by the National Heart, Lung, and Blood Institute’s Framingham Heart Study (N01-HC-25195 and HHSN268201500001I). Health ABC (Health Aging and Body Composition) Study: This research was supported by National Institute on Aging contracts (N01-AG-6-2101, N01-AG-6-2103, and N01-AG-6-2106) and grants (R01-AG028050), and by National Institute of Nursing Research (R01-NR012459). The Jackson Heart Study (JHS) is supported and conducted in collaboration with Jackson State University (HHSN268201800013I), Tougaloo College (HHSN268201800014I), the Mississippi State Department of Health (HHSN268201800015I), and the University of Mississippi Medical Center (HHSN268201800010I, HHSN268201800011I, and HHSN268201800012I) contracts from the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities. The authors also thank the staffs and participants of the JHS. The MESA ( Multi-Ethnic Study of Atherosclerosis): MESA has been funded in whole or in part by The National Heart, Lung, and Blood Institute and the National Institutes of Health (R01-HL-077612, R01-HL-093081, RC1-HL-100543, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169). The Strong Heart Study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services (75N92019D00027, 75N92019D00028, 75N92019D00029, and 75N92019D00030). The study was previously supported by research grants (R01HL109315, R01HL109301, R01HL109284, R01HL109282, and R01HL109319) and by cooperative agreements (U01HL41642, U01HL41652, U01HL41654, U01HL65520, and U01HL65521). This work was supported by a clinical and translational science awards grant (TL1TR001875 to C.M.E.]. This work was supported by additional federal funds from the US National Heart, Lung, and Blood Institute (U54 HL160273 R01 HL107577, R01 HL140731, and R01 HL149423 to S.J.S.). At the time of publication, J.S. was employed by Vertex Pharmaceuticals. S.J.L. is supported by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the US Department of Health and Human Services.
© 2022 The Author(s) 2022.
- Heart failure
- Lung function
- Prospective cohort study
PubMed: MeSH publication types
- Journal Article
- Research Support, N.I.H., Intramural
- Research Support, Non-U.S. Gov't
- Research Support, N.I.H., Extramural