Decline in Lung Function From Mid-to Late-Life With Central Arterial Stiffness: The Atherosclerosis Risk in Communities Study

Abstract

We investigated the association of lung function at mid-life, later in life, and its 20-year decline, with arterial stiffness later in life. We examined 5720 Atherosclerosis Risk in Communities Study participants who attended Visits 1 (1987-1989) and 5 (2011-2013). Lung function measures were forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), obtained at Visits 1, 2 (1990–1992), and 5. Central artery stiffness (carotid-femoral pulse wave velocity [cfPWV]) was measured at Visit 5. We evaluated associations of lung function with later-life central artery stiffness and cfPWV >75th percentile by multivariable linear and logistic regressions. Lung function at Visit 1 (FEV1 β: −26, 95% Confidence Interval [CI]: −48, −5; FVC β: −14, 95% CI: −32, 5) and Visit 5 (FEV1 β: −22, 95% CI: −46, 2; FVC β: −18, 95% CI: −38, 2) were inversely associated with cfPWV at Visit 5, and with odds of high cfPWV in fully adjusted models. Twenty-year decline in lung function was not associated with continuous or dichotomous measures of arterial stiffness (FEV1 β: 11, 95% CI: −46, 68; FVC β: −4, 95% CI: −52, 43). Lung function at mid-life and late-life was inversely associated with arterial stiffness in later life.

Lung Dysfunction and Increased Arterial Stiffness: Causality or Epiphenomenon?

“…6 A causal association could help explain the excess CV morbidity and mortality reported in patients with chronic obstructive pulmonary disease. However, BP and inflammatory state were not tested in a mediation analysis by Peter et al 3 Therefore, causality cannot be confirmed. Alternatively, the association between lung dysfunction and increased arterial stiffness could be non-causal since both arterial and lung function can be affected by an external third factor acting in early life and in the course of life.…”

“…A question raised by the results of Peter et al 3 is whether the association between lung and arterial function is causal or not. Lung dysfunction (exposure) could lead to increased arterial stiffness (outcome).…”

“…1 Recent findings suggest that aortic stiffening is partially reverted in the long-term after resolution of severe inflammation. 2 In an article published in this issue of Angiology, 3 Peter et al reported in 3360 subjects free of lung diseases (age 51 ± 5 years, female sex 60%), that forced expiratory volume in one second (FEV 1 , a measure of lung function representing the maximum amount of air that can be expired in one second), was inversely associated with carotid-femoral pulse wave velocity (cfPWV, a measure of aortic stiffness) measured at baseline and 20 years later. This finding is of clinical interest for the detection of individuals at high risk for CV events and could be helpful to plan early preventive therapeutic strategies.…”

“…An interesting result from the study of Peter et al is that baseline FEV 1 was associated with aortic stiffness measured at the end of follow-up, whereas this association was lost when both FEV 1 and aortic stiffness were measured at follow-up visit, 20 years after the baseline visit. 3 A possible explanation could be a divergent progression of pulmonary and arterial disease over time: the longer the time passed, the greater the difference between lung and arterial function. In this regard, the loss of lung function with age is nonlinear since the decline in FEV 1 increases from 25 to 30 mL/year at age 35-40 years to 60 mL/year after age 70 years.…”

“…10 Peter et al also reported that the 20-year decline in FEV 1 was not associated with cfPWV. 3 This finding could represent a non-biological phenomenon since it may be a consequence of different devices used to measure lung function at baseline and follow-up (comparability of measurements was not documented). In agreement with this hypothesis, a similar absence of association was previously noted by Bolton et al using different devices at different time points, whereas using the same device for the measurement of the lung function at the baseline and follow-up visits, Okamoto et al reported that the decline in lung function was associated with higher arterial stiffness during a 5-year period.…”