Impact of preserved ratio impaired spirometry on coronary artery calcium score progression: a longitudinal cohort study

Yunjoo Im; Hye Yun Park; Jin-Young Lee; Hyunsoo Kim; Hongseok Yoo; Mira Kang; Soo Jin Cho; Jung Hye Hwang; Yong Bum Park; Juhee Cho; Danbee Kang; Sun Hye Shin

doi:10.1183/23120541.00819-2023

Impact of preserved ratio impaired spirometry on coronary artery calcium score progression: a longitudinal cohort study

ERJ Open Res. 2024 Jan 22;10(1):00819-2023. doi: 10.1183/23120541.00819-2023. eCollection 2024 Jan.

Authors

Yunjoo Im^{1

2}, Hye Yun Park^{1

2}, Jin-Young Lee^{3

2}, Hyunsoo Kim⁴, Hongseok Yoo¹, Mira Kang³, Soo Jin Cho³, Jung Hye Hwang³, Yong Bum Park⁵, Juhee Cho^{4

6

7}, Danbee Kang^{4

6

8}, Sun Hye Shin^{1

8}

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
² These authors contributed equally to this work as first authors.
³ Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
⁴ Center for Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea.
⁵ Department of Pulmonary and Critical Care Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea.
⁶ Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
⁷ Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
⁸ These authors contributed equally to this work as senior authors.

Abstract

Background: Preserved ratio impaired spirometry (PRISm) is associated with increased cardiovascular disease (CVD) risk and mortality. However, a causal relationship between PRISm and CVD remains unclear. We investigated the progression of coronary artery calcium (CAC) scores based on the presence of PRISm and reduced forced vital capacity (FVC).

Methods: This retrospective cohort study included 11 420 participants aged ≥40 years with forced expiratory volume in 1 s (FEV₁)/FVC ≥0.7 who underwent at least two health screening examinations with coronary computed tomography scan between 2003 and 2020, and were without a history of CVD or interstitial lung disease. Participants with PRISm, defined as FEV₁/FVC ≥0.7 and FEV₁ <80% predicted, were further divided by low FVC (FVC <80% predicted). We estimated the 5-year progression rates of CAC by comparing participants with and without PRISm at baseline using mixed linear models.

Results: Of the 11 420 participants, 8536 (75%), 811 (7%) and 2073 (18%) had normal spirometry, PRISm with normal FVC and PRISm with low FVC, respectively. During the mean (range) follow-up of 6.0 (0.5-17.2) years, the multivariable adjusted ratio of 5-year CAC progression rates comparing participants with PRISm to those with normal spirometry was 1.08 (95% CI 1.04-1.13). This rate was higher in participants with PRISm with low FVC (1.21 (95% CI 1.12-1.30)) than in those with normal FVC.

Conclusion: In this longitudinal cohort study of subjects without a history of CVD, PRISm was significantly associated with CAC progression, which was more evident in the group with PRISm and low FVC.