Does Poorer Pulmonary Function Accelerate Arterial Stiffening?

Abstract

Whether poorer pulmonary function accelerates progression of arterial stiffness remains unknown as prior observational studies have not examined longitudinal changes in arterial stiffness in relation to earlier pulmonary function. Data (N=5342, 26% female) were drawn from the Whitehall II cohort study. Participants completed repeated assessments of forced expiratory volume in 1 second (FEV1, L) and carotid-femoral pulse wave velocity (cf-PWV, m/s) over 5 years. The effect of FEV1 on later cf-PWV and its progression was estimated using linear mixed-effects modeling. Possible explanatory mechanisms, such as mediation by low-grade systemic inflammation, common-cause explanation by preexisting cardiometabolic risk factors, and reverse-causation bias, were assessed. Poorer pulmonary function was associated with later higher cf-PWV and its subsequent progression (cf-PWV 5-year change 0.09, 95% CI 0.03–0.17 per SD lower FEV1) after adjustment for age, sex, ethnicity, heart rate, and mean arterial pressure. Decrease in pulmonary function was associated with later higher cf-PWV (0.17, 95% CI 0.04–0.30 in the top compared to bottom quartile of decline in FEV1). There was no evidence to support mediation by circulating CRP (C-reactive protein) or IL (interleukin)-6. Furthermore, arterial stiffness was not associated with later FEV1 after accounting for cardiometabolic status. In conclusion, poorer pulmonary function predicted future arterial stiffness. These findings support pulmonary function as a clinically important risk factor for arterial stiffness and provide justification for future intervention studies for pulmonary function based on its relationship with arterial stiffness.

Association of aortic stiffness with cognitive decline: Whitehall II longitudinal cohort study

“…Aortic stiffness, due to loss of elasticity of the artery wall, increases with age and risk factor exposure [4][5][6][7] is associated with higher systolic, pulse pressure and atherosclerosis [8], which are in turn important predictors of cardio-and cerebrovascular morbidity and mortality as well as predictors of cognitive decline [9]. The links between cardiovascular disorders and cognitive decline and dementia remain unclear.…”

The association between carotid-femoral pulse-wave velocity and lung function in the Swedish CArdioPulmonary bioImage study (SCAPIS) cohort

“…The role of spirometry as a predictor of arterial stiffness has been proposed by a few previous studies [9,10]. The mechanisms by which this may occur include acute or chronic inflammation in the respiratory tract (resulting in lower levels of lung function)…”

“…leading to low grade systemic inflammation [10]. The systemic inflammation may then in turn cause vascular remodelling leading to increased arterial stiffness [39].…”

“…However, previous longitudinal studies have found impaired spirometry to be a predictor of arterial stiffness. Reverse causation has been investigated in the past by a study that found weak evidence to support this [10].…”

“…and found low levels of pulmonary function to have a predictive role in the future increase in c-f PWV and suggested lung function could be a novel marker for vascular ageing [10]. The Caerphilly Prospective Study found lung function in mid-life to be a stronger predictor of arterial stiffness compared to later life in men [9].…”