Lung function impairment and risk of incident heart failure: the NHLBI Pooled Cohorts Study

Christina M. Eckhardt, Pallavi P. Balte, Robert Graham Barr, Alain G. Bertoni, Surya P. Bhatt, Michael Cuttica, Patricia A. Cassano, Paolo Chaves, David Couper, David R. Jacobs, Ravi Kalhan, Richard Kronmal, Leslie Lange, Laura Loehr, Stephanie J. London, George T. O'connor, Wayne Rosamond, Jason Sanders, Joseph E. Schwartz, Amil ShahSanjiv J. Shah, Lewis Smith, Wendy White, Sachin Yende, Elizabeth C. Oelsner

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


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 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.

Original languageEnglish (US)
Pages (from-to)2196-2208
Number of pages13
JournalEuropean heart journal
Issue number23
StatePublished - Jun 14 2022

Bibliographical note

Publisher Copyright:
© 2022 The Author(s) 2022.


  • Heart failure
  • Lung function
  • Prospective cohort study
  • Spirometry
  • National Heart, Lung, and Blood Institute (U.S.)
  • Prognosis
  • Humans
  • Lung
  • Risk Factors
  • Stroke Volume/physiology
  • Hospitalization
  • United States/epidemiology
  • Heart Failure
  • Adult

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Intramural
  • Journal Article
  • Research Support, N.I.H., Extramural


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