Lung function and airway obstruction: associations with circulating markers of cardiac function and incident heart failure in older men—the British Regional Heart Study

Abstract

AimsThe association between lung function and cardiac markers and heart failure (HF) has been little studied in the general older population. We have examined the association between lung function and airway obstruction with cardiac markers N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) and risk of incident HF in older men.Methods and resultsProspective study of 3242 men aged 60–79 years without prevalent HF or myocardial infarction followed up for an average period of 13 years, in whom 211 incident HF cases occurred. Incident HF was examined in relation to % predicted FEV1 and FVC. The Global Initiative on Obstructive Lung Diseases spirometry criteria were used to define airway obstruction. Reduced FEV1, but not FVC in the normal range, was significantly associated with increased risk of HF after adjustment for established HF risk factors including inflammation. The adjusted HRs comparing men in the 6–24th percentile with the highest quartile were 1.91 (1.24 to 2.94) and 1.30 (0.86 to 1.96) for FEV1 and FVC, respectively. FEV1 and FVC were inversely associated with NT-proBNP and cTnT, although the association between FEV1 and incident HF remained after adjustment for NT-proBNP and cTnT. Compared with normal subjects (FEV1/FVC ≥0.70 and FVC≥80%), moderate or severe (FEV1/FVC <0.70 and FEV1 <80%) airflow obstruction was independently associated with HF ((adjusted relative risk 1.59 (1.08 to 2.33)). Airflow restriction (FEV1/FVC ≥0.70 and FVC <80%) was not independently associated with HF.ConclusionsReduced FEV1 reflecting airflow obstruction is associated with cardiac dysfunction and increased risk of incident HF in older men.

Serum Conjugated Linoleic Acid and Risk of Incident Heart Failure in Older Men: The British Regional Heart Study

“…The current findings are based on physician‐diagnosed HF, which has yielded estimates of HF incidence consistent with those of earlier reports . Moreover, the determinants of HF in this study population (including obesity, NT‐proBNP, lung function, and heavy drinking) generally accord with prior data and suggest that the HF outcome used was valid. However, echocardiographic measurements were not routinely performed, and we were not able to differentiate systolic and diastolic HF.…”

“…Details of measurement and classification methods for body mass index, smoking status, physical activity, social class, alcohol intake, blood pressure, blood lipids, plasma glucose, renal dysfunction, and forced expiratory volume in 1 second in this cohort have been described. [16][17][18] Prevalent diabetes mellitus included men with a diagnosis of diabetes mellitus and men with a fasting blood glucose level ≥7 mmol/L. NT-proBNP (N-terminal pro-B-type natriuretic peptide) was determined using the Elecsys 2010 (Roche Diagnostics, Burgess Hill, UK).…”

Chronic Obstructive Pulmonary Disease and Cardiac Diseases. An Urgent Need for Integrated Care

“…In this regard, patients with COPD represent a peculiar population, because COPD can influence heart function, thus confounding the results of diagnostic tests. For example, a direct association between NT-proBNP and FEV 1 has been observed in elderly subjects without HF (9). Nevertheless, NT-proBNP improves the diagnostic accuracy of HF in stable COPD (e.g., receiver operating characteristic area increased from 0.70 to 0.77 [56)]) (75).…”

“…Although the lung is usually identified as the primary target organ, smoking greatly affects other organs, such as the heart (5), suggesting that patients with COPD are at increased risk of cardiac diseases (6,7). Also, reduced lung function has been independently correlated with increased risk of heart failure (HF) (8,9), myocardial infarction (MI) (10), and atrial fibrillation (AF) (11). Undeniably, COPD and cardiac diseases share recognized risk factors, such as older age, smoking, and unhealthy lifestyle choices.…”

The restrictive–obstructive continuum and the failing heart

“…However, few studies have explored whether reduced lung function predicts future onset of heart failure. In the current issue of Thorax , Wannamethee et al 15 assessed the relationships between lung function, circulating cardiac markers and incidence of heart failure, in 3242 older men. The research was performed in the British Regional Heart study, a well-known population-based cohort, which was established with the purpose of studying cardiovascular disease and its risk factors.…”