TABLE:
Key studies addressing the clinical and subclinical relationships between pulmonary and heart function.
| Reference | Study type | Associations |
|---|---|---|
| Chen et al (2015)(4) | Systematic review (89 references) and Metanalysis (29 references) mostly observational studies comparing COPD patients to non-COPD population. | - COPD patients are more likely to be diagnosed with: -Any cardiovascular disease: OR 2.46; 95% CI 2.02-3.00; - Coronary artery disease: 2.28; 1.76-2.96; -Arrhythmias: 1.94; 1.55-2.43 including atrial fibrillation; - Heart failure: 2.57; 1.90-3.47; - Diseases of the pulmonary circulation (acute or chronic pulmonary heart disease, pulmonary embolism, and cor pulmonale: 5.14; 4.07-6.50. - COPD patients had greater likelihood to have hypertension (1.33; 1.13-1.56), diabetes (1.36; 1.21-1.53) and ever smoking (4.25; 3.23-5.60). |
| Sidney et al (2005)(6) | Observational study from the Kaiser Permanente Medical Care program, that enrolled 45,966 patients with COPD and compared CVD outcomes with an equal number of controls, matched for gender, birth year and length of membership. |
- COPD was associated with a greater risk of CVD hospitalization and mortality in an average follow up of nearly 3 years, independently of age, gender, hypertension, dyslipidemia and diabetes, after excluding those prevalent CVD at baseline. Highest rate ratios (RR) for hospitalization were: - Heart Failure: RR 3.85; 95% CI 3.44–4.32; - VT/VF/cardiac arrest: 2.78; 1.75, 4.42; and - Pulmonary embolism: 2.74;1.99–3.76. Highest mortality rate ratios were: - Heart Failure: RR 3.50; 2.22–5.50; and - Myocardial infarction: 1.85; 1.55–2.21. |
| Johnston et al (2008)(9) | Observational study of 14681 participants from ARIC cohort to determine the association between lung function impairment with prevalent and incident CVD at baseline and over 15 years of follow-up | - Compared to participants with a normal spirometry, restrictive spirometric pattern showed the highest magnitude of association with CVD at baseline (OR 3.4, 95%CI 2.8-4.2), which persisted even after accounting for several risk factors and covariates (adjusted OR 2.3, 95%CI 1.9-2.9). - In participants free from CVD at baseline, restrictive spirometric pattern was associated to an increased risk for incidental CVD (adjusted HR 1.4, 95%CI 1.02-1.9), when compared to participants with a normal spirometry. |
| Cuttica et al (2018)( 17) | Observational study of 4761 young participants (18-36 years) from CARDIA cohort to determine the association between lung health in young adulthood and risk of subsequent cardiovascular events over 29 years of follow up | - Lower percent predicted FEV1 (adjusted HR 1.18; 95%CI 1.06) and FVC (1.19; 1.06-1.33), but not FEV1/FVC ratio (1.03; 0.93-1.14), was associated with greater risk of the composite of fatal and non-fatal cardiovascular events independent of age, gender, race, education, baseline body mass index, smoking, diabetes, systolic blood pressure, use of anti-hypertensive medication, total and HDL-cholesterol. - Worse FVC in particular was also independently associated with greater risk for incident left heart failure (1.29; 1.03-1.62), while percent predicted FEV1 (1.20; 0,98-1.48) and FEV1/FVC ratio (0.93; 0.75-1.16) were not. |
| Cuttica et al (2015)(38) | Observational study of 3000 young participants from CARDIA cohort to determine the association between lung health in young adulthood and cardiac structure and function over 20 years of follow up | - Decline in FVC (peak – year 20; mean 40mL/year in men and 33mL/year in women) was associated with larger left ventricular mass, greater cardiac output and diastolic dysfunction. - Decline in FEV1/FVC ratio (mean 0.30/year in men and 0.37/year in women) was associated with smaller left atrial internal dimension and lower cardiac output. |
| Silvestre et al (2018)( 18) | Observational study of 10,351 participants from ARIC cohort to evaluate whether longitudinal decline in lung function in 2.9 years is associated with incident heart failure, coronary heart disease, and stroke over 17 years of follow up | - Rapid decline in FEV1 (reduction in >1.9% per year) and in FVC (decline in >2.1% per year) were both associated with a heightened risk of incident HF (HR 1.17; 95% CI 1.04-1.33; and 1.27; 1.12-1.44 respectively), with rapid decline in FEV1 most prognostic in the first year of follow-up (4.22; 1.34-13.26). - Rapid decline in FEV1 was also associated with incident stroke (1.25; 1.04-1.50). - These associations were independent of age, gender, race, height, ARIC center, body mass index, heart rate, low-density lipoprotein cholesterol, lipid-lowering medication, NT-proBNP, diabetes, hypertension, and smoking. |
| Barr et al (2010)(28) | Observational study of 2816 participants from MESA cohort to evaluate the association of emphysema and airflow obstruction, from CT and spirometry, with cardiac structure and function, from MRI | - A 10-point increase in percent emphysema was linearly related to reductions in left ventricular end-diastolic volume (−4.1 mL; 95%CI −3.3 to −4.9; p<0.001), stroke volume (−2.7 mL; 95%CI −2.2 to −3.3; p<0.001), and cardiac output (−0.19L/min; 95%CI −0.14 to −0.23; p<0.001). - Percent emphysema and airflow obstruction were not associated with the left ventricular ejection fraction. |
COPD: chronic obstructive pulmonary disease; OR: odds ratio; CI: confidence interval; RR: rate ratio; CVD: cardiovascular disease; VT/VF: ventricular tachycardia/fibrillation; ARIC: Atherosclerosis Risk in Communities study; FEV1: forced expiratory volume in 1 second; FVC: forced vital capacity; CARDIA: Coronary Artery Risk Development in Young Adults; MESA: Multi-Ethnic Study of Atherosclerosis; CT: computed tomography; MRI: magnetic resonance imaging.