Association of lung function with the risk of cardiovascular diseases and all-cause mortality in patients with diabetes: Results from NHANES III 1988-1994

Nian Huang; Chengyao Tang; Shiyang Li; Wenzhi Ma; Xiaobing Zhai; Keyang Liu; Haytham A Sheerah; Jinhong Cao

doi:10.3389/fcvm.2022.976817

Association of lung function with the risk of cardiovascular diseases and all-cause mortality in patients with diabetes: Results from NHANES III 1988-1994

Front Cardiovasc Med. 2022 Sep 9:9:976817. doi: 10.3389/fcvm.2022.976817. eCollection 2022.

Authors

Nian Huang¹, Chengyao Tang², Shiyang Li¹, Wenzhi Ma¹, Xiaobing Zhai³, Keyang Liu⁴, Haytham A Sheerah^{5

6}, Jinhong Cao¹

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China.
² Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
³ Department of Epidemiology and Biostatistics, School of Medicine, Wuhan University of Science and Technology, Wuhan, China.
⁴ Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
⁵ Health Promotion and Health Education Research Chair, King Saud University, Riyadh, Saudi Arabia.
⁶ Ministry of Health, International Health Regulations, Riyadh, Saudi Arabia.

Abstract

Objective: The potential effects of pulmonary dysfunction on cardiovascular diseases (CVD) and all-cause mortality are receiving attention. The current study aimed to explore whether reduced lung function predicts CVD and all-cause mortality in people with diabetes.

Methods: A total of 1,723 adults with diabetes (mean age 60.2 years) were included in the National Health and Nutrition Examination Survey (NHANES III). Death outcomes were ascertained by linkage to the database records through 31 December 2015. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for coronary heart disease (CHD), CVD, and all-cause mortalities. We conducted stratified analyses based on age, body mass index (BMI), history of hypertension, and dyslipidemia.

Results: During a mean follow-up of 14.62 years (25,184 person-year), a total of 1,221 deaths were documented, of which 327 were CHD, 406 were CVD, and 197 were cancer. After multi-factor adjustment, participants with lower FEV1 and FVC had a higher risk of CHD, CVD, and all-cause mortality. This association was also found in lower FVC and a higher risk of cancer mortality [HR: 3.85 (1.31-11.32); P for trend = 0.040], but the association of FEV1 was attenuated after adjustment for covariates [HR:2.23 (0.54-9.17); P for trend = 0.247]. In subgroup analysis, we found that the adverse associations of FEV1 and FVC with CVD mortality were observed in subgroups of age, BMI, and history of hypertension and dyslipidemia.

Conclusion: Declined lung function was associated with a higher risk of CVD and all-cause mortality in people with diabetes. Lung function tests, especially FEV1 and FVC, should be encouraged to provide prognostic and predictive information for the management of CVD and all-cause mortality in patients with diabetes.

Keywords: National Health and Nutrition Examination Survey (NHANES); cardiovascular disease (CVD); coronary heart disease (CHD); diabetes; forced expiratory volume in 1 s (FEV1); forced vital capacity (FVC).