FEV1 and FVC as robust risk factors for cardiovascular disease and mortality: Insights from a large population study

Andreas Rydell; Christer Janson; Karin Lisspers; Yi-Ting Lin; Johan Ärnlöv

doi:10.1016/j.rmed.2024.107614

FEV₁ and FVC as robust risk factors for cardiovascular disease and mortality: Insights from a large population study

Respir Med. 2024 Apr 25:227:107614. doi: 10.1016/j.rmed.2024.107614. Online ahead of print.

Authors

Andreas Rydell¹, Christer Janson², Karin Lisspers³, Yi-Ting Lin⁴, Johan Ärnlöv⁵

Affiliations

¹ Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Huddinge, Sweden; Centrum För Klinisk Forskning, Region Dalarna, Falun, Sweden. Electronic address: johan.arnlov@ki.se.
² Department of Medical Sciences, Respiratory, Allergy and Sleep Research Uppsala University, Uppsala, Sweden.
³ Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
⁴ Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Huddinge, Sweden.
⁵ Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Huddinge, Sweden; Centrum För Klinisk Forskning, Region Dalarna, Falun, Sweden; School of Health and Welfare, Dalarna University, Falun, Sweden.

PMID: 38670319
DOI: 10.1016/j.rmed.2024.107614

Abstract

Introduction: Data is limited on influence of forced expiratory volume in 1 s (FEV₁) and forced vital capacity (FVC) in a large adult population, including individuals with normal spirometry at baseline.

Methods: Using the UK Biobank cohort, a multivariable Cox regression analysis was conducted on 406,424 individuals to examine the association between FEV₁ and FVC, categorized into three groups based on their percentage of predicted values (%pred) (≥80, 60-80 and < 60), and overall mortality, cardiovascular mortality, myocardial infarction, stroke, and heart failure over approximately 12.5 years. Moreover, a subgroup analysis was conducted on 295,459 individuals who had normal spirometry.

Results: Reduced FEV₁ and FVC %pred values were associated with an elevated risk across all studied outcomes. Individuals with the lowest FEV₁ and FVC %pred values (<60 %) exhibited HR of 1.83 (95 % CI 1.74-1.93) and 1.98 (95 % CI 1.76-2.22) for overall mortality, and 1.96 (95 % CI 1.83-2.1) and 2.26 (95 % CI 1.94-2.63) for cardiovascular mortality. Moreover, a graded association was observed between lower FEV₁ and FVC %pred, even among never smokers and individuals with normal spirometry at baseline.

Discussion: Reduced FEV₁ and FVC represent robust risk factors for cardiovascular disease and mortality. The fact that the increased risk was evident also at FEV₁ and FVC levels exceeding 80 %pred challenges the contemporary classification of lung function categories and the notion that the entire FEV₁- and FVC-range above 80 % of predicted represents a normal lung function.

Keywords: Cardiovascular disease; FEV(1); FVC; Mortality; Population attributable fraction.