Can spirometry improve the performance of cardiovascular risk model in high-risk Eastern European countries?

Tatyana Sarycheva; Naděžda Čapková; Andrzej Pająk; Abdonas Tamošiūnas; Martin Bobák; Hynek Pikhart

doi:10.3389/fcvm.2023.1228807

Can spirometry improve the performance of cardiovascular risk model in high-risk Eastern European countries?

Front Cardiovasc Med. 2023 Aug 29:10:1228807. doi: 10.3389/fcvm.2023.1228807. eCollection 2023.

Authors

Tatyana Sarycheva¹, Naděžda Čapková², Andrzej Pająk³, Abdonas Tamošiūnas⁴, Martin Bobák^{1

5}, Hynek Pikhart^{1

5}

Affiliations

¹ RECETOX, Faculty of Science, Masaryk University, Brno, Czechia.
² Environmental and Population Health Monitoring Centre, The National Institute of Public Health (NIPH), Prague, Czechia.
³ Department of Epidemiology and Population Studies, Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland.
⁴ Laboratory of Population Research, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
⁵ Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.

Abstract

Aims: Impaired lung function has been strongly associated with cardiovascular disease (CVD) events. We aimed to assess the additive prognostic value of spirometry indices to the risk estimation of CVD events in Eastern European populations in this study.

Methods: We randomly selected 14,061 individuals with a mean age of 59 ± 7.3 years without a previous history of cardiovascular and pulmonary diseases from population registers in the Czechia, Poland, and Lithuania. Predictive values of standardised Z-scores of forced expiratory volume measured in 1 s (FEV1), forced vital capacity (FVC), and FEV1 divided by height cubed (FEV1/ht³) were tested. Cox proportional hazards models were used to estimate hazard ratios (HRs) of CVD events of various spirometry indices over the Framingham Risk Score (FRS) model. The model performance was evaluated using Harrell's C-statistics, likelihood ratio tests, and Bayesian information criterion.

Results: All spirometry indices had a strong linear relation with the incidence of CVD events (HR ranged from 1.10 to 1.12 between indices). The model stratified by FEV1/ht³ tertiles had a stronger link with CVD events than FEV1 and FVC. The risk of CVD event for the lowest vs. highest FEV1/ht³ tertile among people with low FRS was higher (HR: 2.35; 95% confidence interval: 1.96-2.81) than among those with high FRS. The addition of spirometry indices showed a small but statistically significant improvement of the FRS model.

Conclusions: The addition of spirometry indices might improve the prediction of incident CVD events particularly in the low-risk group. FEV1/ht³ is a more sensitive predictor compared to other spirometry indices.

Keywords: cardiovascular disease; cohort studies; mortality; pulmonary function test; risk prediction model.

Grants and funding

The authors have disclosed the receipt of the following financial support for the research, authorship, and/or publication of this article: the HAPIEE study was funded by the Welcome Trust (grant WT064947 and WT081081), the US National Institute of Aging (grant R01 AG23522), and the MacArthur Foundation. Contribution of Polish authors was supported by the grant of Polish National Science Centre (grant 2018/29/B/NZ7/02118). The present analyses were supported by the European Union’s Horizon 2020 Research and Innovation Programme projects CETOCOEN Excellence (grant agreement 857560), R-Exposome Chair (grant agreement 857487), and the National Institute for Research of Metabolic and Cardiovascular Disease project (Programme EXCELES, Project ID LX22NPO5104) funded by the EU—Next Generation EU. This publication reflects only the author’s view, and the European Commission is not responsible for any use that may be made of the information it contains. The authors thank the RECETOX Research Infrastructure (No LM2023069) financed by the MEYS and the Operational Programme Research, Development and Education (the CETOCOEN EXCELLENCE project No. CZ.02.1.01/0.0/0.0/17_043/0009632) for supportive background.