ORLANDO – Unselected people from the general population without clinically apparent lung disease but with low lung function had significantly increased mortality during follow-up that was independent of cardiac function, in results from more than 13,000 middle-aged Germans.
“Subtle, subclinical pulmonary impairment is a risk indicator for increased mortality independent of cardiac performance,” Dr. Christina Baum said at the American Heart Association scientific sessions.
Dr. Christina Baum
The researchers used spirometry to measure each subject’s forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). The results showed that “spirometry is a good screening tool that is not very expensive,” making spirometry an effective risk assessment tool for use in the general adult population, said Dr. Baum of the department of general and interventional cardiology at the University Heart Center in Hamburg, Germany.
She and her associates used data collected in the Gutenberg Health Study, which enrolled more than 15,000 German women and men aged 35-74 years during 2007-2012. The investigators excluded people with a history of pulmonary disease, resulting in a study cohort of 13,191, who averaged 55 years old, with 51% men.
At enrollment into the study, all people underwent screening spirometry and echocardiography. Their average baseline FEV1 was 2.9 L and their average FVC was 3.7 L, and 4% had heart failure based on assessments of left ventricular size and function by echocardiography. The first 5,000 enrollees also had measurements taken of their serum levels of N-terminal probrain natriuretic peptide and cardiac troponin I through use of a high-sensitivity assay. The researchers used data from patients followed for a median of 5.5 years.
During follow-up, people in the lowest tertile for FEV1 and those in the lowest tertile for FVC had higher rates of all-cause mortality, compared with those in the highest tertile for each of these two parameters.
In a multivariate analysis that adjusted for age, sex, body mass index, smoking status, hypertension, dyslipidemia, heart failure status, serum levels of N-terminal probrain natriuretic peptide and cardiac troponin I, and other parameters, people with lower FEV1 and FVC readings had significantly worse survival, Dr. Baum said. Every 1–standard deviation increase in FEV1 was linked with a statistically significant, 38% reduced mortality rate; furthermore, a similar significant inverse association existed between FVC and mortality, she reported.
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