Relationship between lung function impairment and incidence or recurrence of cardiovascular events in a middle-aged cohort
Relationship between lung function impairment and incidence or recurrence of cardiovascular events in a middle-aged cohort
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DOI：
10.1136/thx.2007.088112
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发表时间：
2008-07-01
期刊：
影响因子：
10
通讯作者：
Kiri, V. A.
中科院分区：
文献类型：
--
作者：
Johnston, A. K.;Mannino, D. M.;Kiri, V. A.
肺功能损害可能是心血管疾病（CVD）事件的危险因素。目的：在1987年至2001年一组年龄在45-64岁的美国成年人中，确定基于改进的全球阻塞性肺疾病倡议（GOLD）标准的气流阻塞严重程度与CVD患病率、发病率或复发率之间的关系。方法：我们分析了14681名成年人的数据，采用logistic回归确定基线时肺功能损害与CVD患病率之间的横断面关联，并采用Cox回归分析基线时肺功能损害与CVD的前瞻性关联，随访时间超过15年。模型根据年龄、性别、种族、吸烟、合并高血压和糖尿病、胆固醇水平和纤维蛋白原水平进行调整。结果：基线时，与正常受试者相比，GOLD 2 （OR 2.9, 95% CI 2.4 - 3.6）和GOLD 3或4慢性阻塞性肺疾病（COPD） （OR 3.0, 95% CI 2.0 - 4.5）受试者的CVD粗患病率更高。调整协变量后，这些相对风险大大降低（GOLD 2的OR为1.4,95% CI为1.1至1.8，GOLD 3或4的OR为1.3,95% CI为0.8至2.1）。同样，在未调整的模型中，COPD与心血管疾病发生或复发风险之间的关联（GOLD 2的风险比（HR）为2.4,95% CI为2.1至2.7；GOLD 3或4的风险比（HR）为2.9,95% CI为2.2至3.9）要比调整后的模型强得多（GOLD 2的风险比为1.2,95% CI为1.03至1.4；GOLD 3或4的风险比为1.5,95% CI为1.1至2.0）。结论：我们观察到肺功能损害与CVD的流行、发生或复发之间存在粗略的关联，在调整了协变量（包括年龄、性别、种族、吸烟、合并症高血压和糖尿病、胆固醇水平和纤维蛋白原水平）后，这种关联大大降低。这些数据表明，这种关联可能在一定程度上是通过我们调整后的模型中已建立的心血管疾病危险因素介导的。
Introduction: Lung function impairment may be a risk factor for cardiovascular disease (CVD) events.Objective: To determine the relationship between the severity of airflow obstruction based on modified Global Initiative on Obstructive Lung Disease (GOLD) criteria and the prevalence and incidence or recurrence of CVD in a cohort of US adults, aged 45-64 years, from 1987 to 2001.Methods: We analysed data from 14 681 adults using logistic regression to determine the cross sectional association between lung function impairment and prevalent CVD at baseline and Cox regression to examine the prospective association of lung function impairment at baseline with CVD over 15 years of follow-up. Models were adjusted for age, sex, race, smoking, comorbid hypertension and diabetes, cholesterol levels and fibrinogen level.Results: At baseline, the crude prevalence of CVD was higher among subjects with GOLD 2 (OR 2.9, 95% CI 2.4 to 3.6) and GOLD 3 or 4 chronic obstructive pulmonary disease (COPD) (OR 3.0, 95% CI 2.0 to 4.5), compared with normal subjects. These relative risks were greatly reduced after adjusting for covariates (OR 1.4, 95% CI 1.1 to 1.8 for GOLD 2 and OR 1.3, 95% CI 0.8 to 2.1 for GOLD 3 or 4). Similarly, the association between COPD and risk of incident or recurrent CVD was much stronger in the unadjusted models (hazard ratio (HR) 2.4, 95% CI 2.1 to 2.7 for GOLD 2 and 2.9, 95% CI 2.2 to 3.9 for GOLD 3 or 4) than in the adjusted ones (HR 1.2, 95% CI 1.03 to 1.4 for GOLD 2 and 1.5, 95% CI 1.1 to 2.0 for GOLD 3 or 4).Conclusion: We observed a crude association between lung function impairment and prevalent and incident or recurrent CVD that was greatly reduced after adjusting for covariates, including age, sex, race, smoking, comorbid hypertension and diabetes, cholesterol levels and fibrinogen level. These data suggest that this association may be, in part, mediated through established CVD risk factors included in our adjusted models.