Lung Function and Cardiovascular Risk

Abstract

Background-The inverse relationship between pulmonary function and incidence of cardiovascular disease remains largely unexplained. This prospective study explored the hypothesis of a relationship with inflammation-sensitive plasma proteins. Methods and Results-Forced vital capacity (FVC) and plasma levels of fibrinogen, ␣ 1 -antitrypsin, haptoglobin, ceruloplasmin, and orosomucoid were determined in 5064 healthy men aged 28 to 61 years. All-cause mortality, cardiovascular mortality, and incidence of myocardial infarction were monitored over a mean follow-up period of 18.4 years. Low FVC (fourth quartile) was associated with higher protein levels and with increased incidences of myocardial infarction and cardiovascular death. Adjustments for protein levels reduced the age-adjusted relative risks (RRs) for myocardial infarction (from 1.99, 95% CI 1.5 to 2.6, to 1.70, 95% CI 1.3 to 2.2) and cardiovascular death (from 2.71, 95% CI 1.9 to 3.9, to 2.28, 95% CI 1.6 to 3.3) among men with low FVC, corresponding to Ϸ25% of the excess risk.The risk factor-adjusted RRs were reduced from 1.45 (95% CI 1.1 to 1.9) to 1.38 (95% CI 1.1 to 1.8) and from 1.96 (95% CI 1.4 to 2.8) to 1.85 (95% CI 1.3 to 2.7) for myocardial infarction and cardiovascular death, respectively, corresponding to Ϸ10% to 15% of the excess risk. Among men with low FVC, the risk factor-adjusted RR for myocardial infarction was 2.5 (95% CI 1.7 to 3.6) for those with high protein levels (Ն2 proteins in top quartile) and 1.7 (95% CI 1.1 to 2.4) for those with low protein levels (Յ1 protein in top quartile; reference, top quartile of FVC and low protein levels). Conclusions-FVC is significantly and inversely associated with plasma levels of inflammation-sensitive plasma proteins.This relationship contributes to but cannot fully explain the increased cardiovascular risk among men with low FVC.

Inflammation as Possible Mediator for the Relationship Between Lung and Arterial Function

“…Heart rate and mean arterial pressure included as additional covariates in models with pulse wave velocity as dependent variable. p values B0.05 regarded as significant SE standard error Lung than those used in our study and could have a greater contribution to arterial stiffening and CV risk [4]. In a population already afflicted by a significant burden of hypertension [16,48] and a low percentage of anti-hypertensive medication usage-which is indicative of poor diagnosis and control-it is important to investigate and understand all of the factors that may lead to the development of CVD.…”

“…Reduced lung function, as measured by forced expiratory volume in 1 s (FEV 1 ) and forced vital capacity (FVC), is associated with an increased risk for the development of hypertension [1][2][3] and cardiovascular disease (CVD) [4]. Although the association between lung function and CVD is clear, the mechanistic underpinnings of this association remain largely unexplained.…”

Assessment of the Presence of Occult Myocardial Infarction in Chronic Obstructive Pulmonary Disease Using Contrast-Enhanced Cardiac Magnetic Resonance Imaging

“…A diagnosis of COPD confers a cardiovascular mortality of 2–3 times that seen within the general population [3, 4]. Airflow obstruction, in particular forced expiratory volume in 1 s (FEV 1 ), appears to be a strong, independent predictor of mortality from ischaemic heart disease (IHD), even when adjusted for cigarette smoking [3].…”

Pulmonary Dysfunction Is Possibly a Marker of Malnutrition and Inflammation but Not Mortality in Patients with End-Stage Renal Disease

“…Recently, nonclassic risk factors for ESRD have also been identified and include endothelial dysfunction, malnutrition and chronic inflammation [4]. Approximately 30–50% of patients with ESRD have serological evidence of an activated inflammatory response as evidenced by elevated serum levels of C reactive protein (CRP) [5]. An activated inflammatory response is associated with cardiovascular disease, cerebrovascular disease and atherosclerosis [6].…”