TY - JOUR T1 - Harmonization of Respiratory Data From 9 US Population-Based Cohorts: The NHLBI Pooled Cohorts Study. JF - Am J Epidemiol Y1 - 2018 A1 - Oelsner, Elizabeth C A1 - Balte, Pallavi P A1 - Cassano, Patricia A A1 - Couper, David A1 - Enright, Paul L A1 - Folsom, Aaron R A1 - Hankinson, John A1 - Jacobs, David R A1 - Kalhan, Ravi A1 - Kaplan, Robert A1 - Kronmal, Richard A1 - Lange, Leslie A1 - Loehr, Laura R A1 - London, Stephanie J A1 - Navas Acien, Ana A1 - Newman, Anne B A1 - O'Connor, George T A1 - Schwartz, Joseph E A1 - Smith, Lewis J A1 - Yeh, Fawn A1 - Zhang, Yiyi A1 - Moran, Andrew E A1 - Mwasongwe, Stanford A1 - White, Wendy B A1 - Yende, Sachin A1 - Barr, R Graham AB -

Chronic lower respiratory diseases (CLRDs) are the fourth leading cause of death in the United States. To support investigations into CLRD risk determinants and new approaches to primary prevention, we aimed to harmonize and pool respiratory data from US general population-based cohorts. Data were obtained from prospective cohorts that performed prebronchodilator spirometry and were harmonized following 2005 ATS/ERS standards. In cohorts conducting follow-up for noncardiovascular events, CLRD events were defined as hospitalizations/deaths adjudicated as CLRD-related or assigned relevant administrative codes. Coding and variable names were applied uniformly. The pooled sample included 65,251 adults in 9 cohorts followed-up for CLRD-related mortality over 653,380 person-years during 1983-2016. Average baseline age was 52 years; 56% were female; 49% were never-smokers; and racial/ethnic composition was 44% white, 22% black, 28% Hispanic/Latino, and 5% American Indian. Over 96% had complete data on smoking, clinical CLRD diagnoses, and dyspnea. After excluding invalid spirometry examinations (13%), there were 105,696 valid examinations (median, 2 per participant). Of 29,351 participants followed for CLRD hospitalizations, median follow-up was 14 years; only 5% were lost to follow-up at 10 years. The NHLBI Pooled Cohorts Study provides a harmonization standard applied to a large, US population-based sample that may be used to advance epidemiologic research on CLRD.

VL - 187 IS - 11 ER - TY - JOUR T1 - Albuminuria, Lung Function Decline, and Risk of Incident Chronic Obstructive Pulmonary Disease. The NHLBI Pooled Cohorts Study. JF - Am J Respir Crit Care Med Y1 - 2019 A1 - Oelsner, Elizabeth C A1 - Balte, Pallavi P A1 - Grams, Morgan E A1 - Cassano, Patricia A A1 - Jacobs, David R A1 - Barr, R Graham A1 - Burkart, Kristin M A1 - Kalhan, Ravi A1 - Kronmal, Richard A1 - Loehr, Laura R A1 - O'Connor, George T A1 - Schwartz, Joseph E A1 - Shlipak, Michael A1 - Tracy, Russell P A1 - Tsai, Michael Y A1 - White, Wendy A1 - Yende, Sachin AB -

RATIONALE: Chronic lower respiratory diseases (CLRDs), including chronic obstructive pulmonary disease (COPD) and asthma, are the fourth leading cause of death. Prior studies suggest that albuminuria, a biomarker of endothelial injury, is increased in patients with COPD.

OBJECTIVES: To test whether albuminuria was associated with lung function decline and incident CLRDs.

METHODS: Six U.S. population-based cohorts were harmonized and pooled. Participants with prevalent clinical lung disease were excluded. Albuminuria (urine albumin-to-creatinine ratio) was measured in spot samples. Lung function was assessed by spirometry. Incident CLRD-related hospitalizations and deaths were classified via adjudication and/or administrative criteria. Mixed and proportional hazards models were used to test individual-level associations adjusted for age, height, weight, sex, race/ethnicity, education, birth year, cohort, smoking status, pack-years of smoking, renal function, hypertension, diabetes, and medications.

MEASUREMENTS AND MAIN RESULTS: Among 10,961 participants with preserved lung function, mean age at albuminuria measurement was 60 years, 51% were never-smokers, median albuminuria was 5.6 mg/g, and mean FEV decline was 31.5 ml/yr. For each SD increase in log-transformed albuminuria, there was 2.81% greater FEV decline (95% confidence interval [CI], 0.86-4.76%; P = 0.0047), 11.02% greater FEV/FVC decline (95% CI, 4.43-17.62%; P = 0.0011), and 15% increased hazard of incident spirometry-defined moderate-to-severe COPD (95% CI, 2-31%, P = 0.0021). Each SD log-transformed albuminuria increased hazards of incident COPD-related hospitalization/mortality by 26% (95% CI, 18-34%, P < 0.0001) among 14,213 participants followed for events. Asthma events were not significantly associated. Associations persisted in participants without current smoking, diabetes, hypertension, or cardiovascular disease.

CONCLUSIONS: Albuminuria was associated with greater lung function decline, incident spirometry-defined COPD, and incident COPD-related events in a U.S. population-based sample.

VL - 199 IS - 3 ER - TY - JOUR T1 - Discriminative Accuracy of FEV1:FVC Thresholds for COPD-Related Hospitalization and Mortality. JF - JAMA Y1 - 2019 A1 - Bhatt, Surya P A1 - Balte, Pallavi P A1 - Schwartz, Joseph E A1 - Cassano, Patricia A A1 - Couper, David A1 - Jacobs, David R A1 - Kalhan, Ravi A1 - O'Connor, George T A1 - Yende, Sachin A1 - Sanders, Jason L A1 - Umans, Jason G A1 - Dransfield, Mark T A1 - Chaves, Paulo H A1 - White, Wendy B A1 - Oelsner, Elizabeth C KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Female KW - Forced Expiratory Volume KW - Hospitalization KW - Humans KW - Male KW - Middle Aged KW - Prognosis KW - Proportional Hazards Models KW - Pulmonary Disease, Chronic Obstructive KW - Risk Assessment KW - Vital Capacity AB -

Importance: According to numerous current guidelines, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of the forced expiratory volume in the first second to the forced vital capacity (FEV1:FVC) of less than 0.70, yet this fixed threshold is based on expert opinion and remains controversial.

Objective: To determine the discriminative accuracy of various FEV1:FVC fixed thresholds for predicting COPD-related hospitalization and mortality.

Design, Setting, and Participants: The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study harmonized and pooled data from 4 US general population-based cohorts (Atherosclerosis Risk in Communities Study; Cardiovascular Health Study; Health, Aging, and Body Composition Study; and Multi-Ethnic Study of Atherosclerosis). Participants aged 45 to 102 years were enrolled from 1987 to 2000 and received follow-up longitudinally through 2016.

Exposures: Presence of airflow obstruction, which was defined by a baseline FEV1:FVC less than a range of fixed thresholds (0.75 to 0.65) or less than the lower limit of normal as defined by Global Lung Initiative reference equations (LLN).

Main Outcomes and Measures: The primary outcome was a composite of COPD hospitalization and COPD-related mortality, defined by adjudication or administrative criteria. The optimal fixed FEV1:FVC threshold was defined by the best discrimination for these COPD-related events as indexed using the Harrell C statistic from unadjusted Cox proportional hazards models. Differences in C statistics were compared with respect to less than 0.70 and less than LLN thresholds using a nonparametric approach.

Results: Among 24 207 adults in the pooled cohort (mean [SD] age at enrollment, 63 [10.5] years; 12 990 [54%] women; 16 794 [69%] non-Hispanic white; 15 181 [63%] ever smokers), complete follow-up was available for 11 077 (77%) at 15 years. During a median follow-up of 15 years, 3925 participants experienced COPD-related events over 340 757 person-years of follow-up (incidence density rate, 11.5 per 1000 person-years), including 3563 COPD-related hospitalizations and 447 COPD-related deaths. With respect to discrimination of COPD-related events, the optimal fixed threshold (0.71; C statistic for optimal fixed threshold, 0.696) was not significantly different from the 0.70 threshold (difference, 0.001 [95% CI, -0.002 to 0.004]) but was more accurate than the LLN threshold (difference, 0.034 [95% CI, 0.028 to 0.041]). The 0.70 threshold provided optimal discrimination in the subgroup analysis of ever smokers and in adjusted models.

Conclusions and Relevance: Defining airflow obstruction as FEV1:FVC less than 0.70 provided discrimination of COPD-related hospitalization and mortality that was not significantly different or was more accurate than other fixed thresholds and the LLN. These results support the use of FEV1:FVC less than 0.70 to identify individuals at risk of clinically significant COPD.

VL - 321 IS - 24 ER - TY - JOUR T1 - Association of Nonobstructive Chronic Bronchitis With Respiratory Health Outcomes in Adults. JF - JAMA Intern Med Y1 - 2020 A1 - Balte, Pallavi P A1 - Chaves, Paulo H M A1 - Couper, David J A1 - Enright, Paul A1 - Jacobs, David R A1 - Kalhan, Ravi A1 - Kronmal, Richard A A1 - Loehr, Laura R A1 - London, Stephanie J A1 - Newman, Anne B A1 - O'Connor, George T A1 - Schwartz, Joseph E A1 - Smith, Benjamin M A1 - Smith, Lewis J A1 - White, Wendy B A1 - Yende, Sachin A1 - Oelsner, Elizabeth C KW - Adolescent KW - Adult KW - Aged KW - Aged, 80 and over KW - Asthma KW - Bronchitis, Chronic KW - Female KW - Humans KW - Lung KW - Male KW - Middle Aged KW - Prospective Studies KW - Respiratory Function Tests KW - Smokers KW - Smoking KW - Young Adult AB -

Importance: Chronic bronchitis has been associated with cigarette smoking as well as with e-cigarette use among young adults, but the association of chronic bronchitis in persons without airflow obstruction or clinical asthma, described as nonobstructive chronic bronchitis, with respiratory health outcomes remains uncertain.

Objective: To assess whether nonobstructive chronic bronchitis is associated with adverse respiratory health outcomes in adult ever smokers and never smokers.

Design, Setting, and Participants: This prospective cohort study included 22 325 adults without initial airflow obstruction (defined as the ratio of forced expiratory volume in the first second [FEV1] to forced vital capacity [FVC] of <0.70) or clinical asthma at baseline. The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study harmonized and pooled data from 9 US general population-based cohorts. Thus present study is based on data from 5 of these cohorts. Participants were enrolled from August 1971 through May 2007 and were followed up through December 2018.

Exposures: Nonobstructive chronic bronchitis was defined by questionnaire at baseline as both cough and phlegm for at least 3 months for at least 2 consecutive years.

Main Outcomes and Measures: Lung function was measured by prebronchodilator spirometry. Hospitalizations and deaths due to chronic lower respiratory disease and respiratory disease-related mortality were defined by events adjudication and administrative criteria. Models were stratified by smoking status and adjusted for anthropometric, sociodemographic, and smoking-related factors. The comparison group was participants without nonobstructive chronic bronchitis.

Results: Among 22 325 adults included in the analysis, mean (SD) age was 53.0 (16.3) years (range, 18.0-95.0 years), 58.2% were female, 65.9% were non-Hispanic white, and 49.6% were ever smokers. Among 11 082 ever smokers with 99 869 person-years of follow-up, participants with nonobstructive chronic bronchitis (300 [2.7%]) had accelerated decreases in FEV1 (4.1 mL/y; 95% CI, 2.1-6.1 mL/y) and FVC (4.7 mL/y; 95% CI, 2.2-7.2 mL/y), increased risks of chronic lower respiratory disease-related hospitalization or mortality (hazard ratio [HR], 2.2; 95% CI, 1.7-2.7), and greater respiratory disease-related (HR, 2.0; 95% CI, 1.1-3.8) and all-cause mortality (HR, 1.5; 95% CI, 1.3-1.8) compared with ever smokers without nonobstructive chronic bronchitis. Among 11 243 never smokers with 120 004 person-years of follow-up, participants with nonobstructive chronic bronchitis (151 [1.3%]) had greater rates of chronic lower respiratory disease-related hospitalization or mortality (HR, 3.1; 95% CI, 2.1-4.5) compared with never smokers without nonobstructive chronic bronchitis. Nonobstructive chronic bronchitis was not associated with FEV1:FVC decline or incident airflow obstruction. The presence of at least 1 of the component symptoms of nonobstructive chronic bronchitis (ie, chronic cough or phlegm), which was common in both ever smokers (11.0%) and never smokers (6.7%), was associated with adverse respiratory health outcomes.

Conclusions and Relevance: The findings suggest that nonobstructive chronic bronchitis is associated with adverse respiratory health outcomes, particularly in ever smokers, and may be a high-risk phenotype suitable for risk stratification and targeted therapies.

VL - 180 IS - 5 ER - TY - JOUR T1 - A Dyadic Growth Modeling Approach for Examining Associations Between Weight Gain and Lung Function Decline. JF - Am J Epidemiol Y1 - 2020 A1 - Cornelius, Talea A1 - Schwartz, Joseph E A1 - Balte, Pallavi A1 - Bhatt, Surya P A1 - Cassano, Patricia A A1 - Currow, David A1 - Jacobs, David R A1 - Johnson, Miriam A1 - Kalhan, Ravi A1 - Kronmal, Richard A1 - Loehr, Laura A1 - O'Connor, George T A1 - Smith, Benjamin A1 - White, Wendy B A1 - Yende, Sachin A1 - Oelsner, Elizabeth C KW - Adult KW - Aged KW - Body Mass Index KW - Cohort Studies KW - Humans KW - Linear Models KW - Lung KW - Middle Aged KW - Respiratory Function Tests KW - Weight Gain AB -

The relationship between body weight and lung function is complex. Using a dyadic multilevel linear modeling approach, treating body mass index (BMI; weight (kg)/height (m)2) and lung function as paired, within-person outcomes, we tested the hypothesis that persons with more rapid increase in BMI exhibit more rapid decline in lung function, as measured by forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and their ratio (FEV1:FVC). Models included random intercepts and slopes and adjusted for sociodemographic and smoking-related factors. A sample of 9,115 adults with paired measurements of BMI and lung function taken at ≥3 visits were selected from a pooled set of 5 US population-based cohort studies (1983-2018; mean age at baseline = 46 years; median follow-up, 19 years). At age 46 years, average annual rates of change in BMI, FEV1, FVC, and FEV1:FVC ratio were 0.22 kg/m2/year, -25.50 mL/year, -21.99 mL/year, and -0.24%/year, respectively. Persons with steeper BMI increases had faster declines in FEV1 (r = -0.16) and FVC (r = -0.26) and slower declines in FEV1:FVC ratio (r = 0.11) (all P values < 0.0001). Results were similar in subgroup analyses. Residual correlations were negative (P < 0.0001), suggesting additional interdependence between BMI and lung function. Results show that greater rates of weight gain are associated with greater rates of lung function loss.

VL - 189 IS - 10 ER - TY - JOUR T1 - Lung function decline in former smokers and low-intensity current smokers: a secondary data analysis of the NHLBI Pooled Cohorts Study. JF - Lancet Respir Med Y1 - 2020 A1 - Oelsner, Elizabeth C A1 - Balte, Pallavi P A1 - Bhatt, Surya P A1 - Cassano, Patricia A A1 - Couper, David A1 - Folsom, Aaron R A1 - Freedman, Neal D A1 - Jacobs, David R A1 - Kalhan, Ravi A1 - Mathew, Amanda R A1 - Kronmal, Richard A A1 - Loehr, Laura R A1 - London, Stephanie J A1 - Newman, Anne B A1 - O'Connor, George T A1 - Schwartz, Joseph E A1 - Smith, Lewis J A1 - White, Wendy B A1 - Yende, Sachin KW - Adult KW - Aged KW - Case-Control Studies KW - Ex-Smokers KW - Female KW - Follow-Up Studies KW - Humans KW - Lung KW - Male KW - Middle Aged KW - National Heart, Lung, and Blood Institute (U.S.) KW - Non-Smokers KW - Respiratory Physiological Phenomena KW - Smokers KW - Smoking KW - Spirometry KW - United States KW - Young Adult AB -

BACKGROUND: Former smokers now outnumber current smokers in many developed countries, and current smokers are smoking fewer cigarettes per day. Some data suggest that lung function decline normalises with smoking cessation; however, mechanistic studies suggest that lung function decline could continue. We hypothesised that former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers, including among those without prevalent lung disease.

METHODS: We used data on six US population-based cohorts included in the NHLBI Pooled Cohort Study. We restricted the sample to participants with valid spirometry at two or more exams. Two cohorts recruited younger adults (≥17 years), two recruited middle-aged and older adults (≥45 years), and two recruited only elderly adults (≥65 years) with examinations done between 1983 and 2014. FEV decline in sustained former smokers and current smokers was compared to that of never-smokers by use of mixed models adjusted for sociodemographic and anthropometric factors. Differential FEV decline was also evaluated according to duration of smoking cessation and cumulative (number of pack-years) and current (number of cigarettes per day) cigarette consumption.

FINDINGS: 25 352 participants (ages 17-93 years) completed 70 228 valid spirometry exams. Over a median follow-up of 7 years (IQR 3-20), FEV decline at the median age (57 years) was 31·01 mL per year (95% CI 30·66-31·37) in sustained never-smokers, 34·97 mL per year (34·36-35·57) in former smokers, and 39·92 mL per year (38·92-40·92) in current smokers. With adjustment, former smokers showed an accelerated FEV decline of 1·82 mL per year (95% CI 1·24-2·40) compared to never-smokers, which was approximately 20% of the effect estimate for current smokers (9·21 mL per year; 95% CI 8·35-10·08). Compared to never-smokers, accelerated FEV decline was observed in former smokers for decades after smoking cessation and in current smokers with low cumulative cigarette consumption (<10 pack-years). With respect to current cigarette consumption, the effect estimate for FEV decline in current smokers consuming less than five cigarettes per day (7·65 mL per year; 95% CI 6·21-9·09) was 68% of that in current smokers consuming 30 or more cigarettes per day (11·24 mL per year; 9·86-12·62), and around five times greater than in former smokers (1·57 mL per year; 1·00-2·14). Among participants without prevalent lung disease, associations were attenuated but were consistent with the main results.

INTERPRETATION: Former smokers and low-intensity current smokers have accelerated lung function decline compared with never-smokers. These results suggest that all levels of smoking exposure are likely to be associated with lasting and progressive lung damage.

FUNDING: National Institutes of Health, National Heart Lung and Blood Institute, and US Environmental Protection Agency.

VL - 8 IS - 1 ER - TY - JOUR T1 - Association Between Preserved Ratio Impaired Spirometry and Clinical Outcomes in US Adults. JF - JAMA Y1 - 2021 A1 - Wan, Emily S A1 - Balte, Pallavi A1 - Schwartz, Joseph E A1 - Bhatt, Surya P A1 - Cassano, Patricia A A1 - Couper, David A1 - Daviglus, Martha L A1 - Dransfield, Mark T A1 - Gharib, Sina A A1 - Jacobs, David R A1 - Kalhan, Ravi A1 - London, Stephanie J A1 - Navas-Acien, Ana A1 - O'Connor, George T A1 - Sanders, Jason L A1 - Smith, Benjamin M A1 - White, Wendy A1 - Yende, Sachin A1 - Oelsner, Elizabeth C KW - Adult KW - Aged KW - Aged, 80 and over KW - Cardiovascular Diseases KW - Female KW - Forced Expiratory Volume KW - Humans KW - Lung KW - Lung Diseases KW - Male KW - Middle Aged KW - Prevalence KW - Retrospective Studies KW - Spirometry KW - United States KW - Vital Capacity AB -

Importance: Chronic lung diseases are a leading cause of morbidity and mortality. Unlike chronic obstructive pulmonary disease, clinical outcomes associated with proportional reductions in expiratory lung volumes without obstruction, otherwise known as preserved ratio impaired spirometry (PRISm), are poorly understood.

Objective: To examine the prevalence, correlates, and clinical outcomes associated with PRISm in US adults.

Design, Setting, and Participants: The National Heart, Lung, and Blood Institute (NHLBI) Pooled Cohorts Study was a retrospective study with harmonized pooled data from 9 US general population-based cohorts (enrollment, 65 251 participants aged 18 to 102 years of whom 53 701 participants had valid baseline lung function) conducted from 1971-2011 (final follow-up, December 2018).

Exposures: Participants were categorized into mutually exclusive groups by baseline lung function. PRISm was defined as the ratio of forced expiratory volume in the first second to forced vital capacity (FEV1:FVC) greater than or equal to 0.70 and FEV1 less than 80% predicted; obstructive spirometry FEV1:FVC ratio of less than 0.70; and normal spirometry FEV1:FVC ratio greater than or equal to 0.7 and FEV1 greater than or equal to 80% predicted.

Main Outcomes and Measures: Main outcomes were all-cause mortality, respiratory-related mortality, coronary heart disease (CHD)-related mortality, respiratory-related events (hospitalizations and mortality), and CHD-related events (hospitalizations and mortality) classified by adjudication or validated administrative criteria. Absolute risks were adjusted for age and smoking status. Poisson and Cox proportional hazards models comparing PRISm vs normal spirometry were adjusted for age, sex, race and ethnicity, education, body mass index, smoking status, cohort, and comorbidities.

Results: Among all participants (mean [SD] age, 53.2 [15.8] years, 56.4% women, 48.5% never-smokers), 4582 (8.5%) had PRISm. The presence of PRISm relative to normal spirometry was significantly associated with obesity (prevalence, 48.3% vs 31.4%; prevalence ratio [PR], 1.68 [95% CI, 1.55-1.82]), underweight (prevalence, 1.4% vs 1.0%; PR, 2.20 [95% CI, 1.72-2.82]), female sex (prevalence, 60.3% vs 59.0%; PR, 1.07 [95% CI, 1.01-1.13]), and current smoking (prevalence, 25.2% vs 17.5%; PR, 1.33 [95% CI, 1.22-1.45]). PRISm, compared with normal spirometry, was significantly associated with greater all-cause mortality (29.6/1000 person-years vs 18.0/1000 person-years; difference, 11.6/1000 person-years [95% CI, 10.0-13.1]; adjusted hazard ratio [HR], 1.50 [95% CI, 1.42-1.59]), respiratory-related mortality (2.1/1000 person-years vs 1.0/1000 person-years; difference, 1.1/1000 person-years [95% CI, 0.7-1.6]; adjusted HR, 1.95 [95% CI, 1.54-2.48]), CHD-related mortality (5.4/1000 person-years vs 2.6/1000 person-years; difference, 2.7/1000 person-years [95% CI, 2.1-3.4]; adjusted HR, 1.55 [95% CI, 1.36-1.77]), respiratory-related events (12.2/1000 person-years vs 6.0/1000 person-years; difference, 6.2/1000 person-years [95% CI, 4.9-7.5]; adjusted HR, 1.90 [95% CI, 1.69-2.14]), and CHD-related events (11.7/1000 person-years vs 7.0/1000 person-years; difference, 4.7/1000 person-years [95% CI, 3.7-5.8]; adjusted HR, 1.30 [95% CI, 1.18-1.42]).

Conclusions and Relevance: In a large, population-based sample of US adults, baseline PRISm, compared with normal spirometry, was associated with a small but statistically significant increased risk for mortality and adverse cardiovascular and respiratory outcomes. Further research is needed to explore whether this association is causal.

VL - 326 IS - 22 ER - TY - JOUR T1 - Lung function impairment and risk of incident heart failure: the NHLBI Pooled Cohorts Study. JF - Eur Heart J Y1 - 2022 A1 - Eckhardt, Christina M A1 - Balte, Pallavi P A1 - Barr, Robert Graham A1 - Bertoni, Alain G A1 - Bhatt, Surya P A1 - Cuttica, Michael A1 - Cassano, Patricia A A1 - Chaves, Paolo A1 - Couper, David A1 - Jacobs, David R A1 - Kalhan, Ravi A1 - Kronmal, Richard A1 - Lange, Leslie A1 - Loehr, Laura A1 - London, Stephanie J A1 - O'Connor, George T A1 - Rosamond, Wayne A1 - Sanders, Jason A1 - Schwartz, Joseph E A1 - Shah, Amil A1 - Shah, Sanjiv J A1 - Smith, Lewis A1 - White, Wendy A1 - Yende, Sachin A1 - Oelsner, Elizabeth C KW - Adult KW - Heart Failure KW - Hospitalization KW - Humans KW - Lung KW - National Heart, Lung, and Blood Institute (U.S.) KW - Prognosis KW - Risk Factors KW - Stroke Volume KW - United States AB -

AIMS: The aim is to evaluate associations of lung function impairment with risk of incident heart failure (HF).

METHODS AND RESULTS: Data were pooled across eight US population-based cohorts that enrolled participants from 1987 to 2004. Participants with self-reported baseline cardiovascular disease were excluded. Spirometry was used to define obstructive [forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) <0.70] or restrictive (FEV1/FVC ≥0.70, FVC <80%) lung physiology. The incident HF was defined as hospitalization or death caused by HF. In a sub-set, HF events were sub-classified as HF with reduced ejection fraction (HFrEF; EF <50%) or preserved EF (HFpEF; EF ≥50%). The Fine-Gray proportional sub-distribution hazards models were adjusted for sociodemographic factors, smoking, and cardiovascular risk factors. In models of incident HF sub-types, HFrEF, HFpEF, and non-HF mortality were treated as competing risks. Among 31 677 adults, there were 3344 incident HF events over a median follow-up of 21.0 years. Of 2066 classifiable HF events, 1030 were classified as HFrEF and 1036 as HFpEF. Obstructive [adjusted hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.07-1.27] and restrictive physiology (adjusted HR 1.43, 95% CI 1.27-1.62) were associated with incident HF. Obstructive and restrictive ventilatory defects were associated with HFpEF but not HFrEF. The magnitude of the association between restrictive physiology and HFpEF was similar to associations with hypertension, diabetes, and smoking.

CONCLUSION: Lung function impairment was associated with increased risk of incident HF, and particularly incident HFpEF, independent of and to a similar extent as major known cardiovascular risk factors.

VL - 43 IS - 23 ER - TY - JOUR T1 - Pooled Cohort Probability Score for Subclinical Airflow Obstruction. JF - Ann Am Thorac Soc Y1 - 2022 A1 - Bhatt, Surya P A1 - Balte, Pallavi P A1 - Schwartz, Joseph E A1 - Jaeger, Byron C A1 - Cassano, Patricia A A1 - Chaves, Paulo H A1 - Couper, David A1 - Jacobs, David R A1 - Kalhan, Ravi A1 - Kaplan, Robert A1 - Lloyd-Jones, Donald A1 - Newman, Anne B A1 - O'Connor, George A1 - Sanders, Jason L A1 - Smith, Benjamin M A1 - Sun, Yifei A1 - Umans, Jason G A1 - White, Wendy B A1 - Yende, Sachin A1 - Oelsner, Elizabeth C KW - Adult KW - Female KW - Forced Expiratory Volume KW - Humans KW - Lung KW - Male KW - Middle Aged KW - Nutrition Surveys KW - Pulmonary Disease, Chronic Obstructive KW - Risk Factors KW - Spirometry KW - Vital Capacity AB -

Early detection of chronic obstructive pulmonary disease (COPD) is a public health priority. Airflow obstruction is the single most important risk factor for adverse COPD outcomes, but spirometry is not routinely recommended for screening. To describe the burden of subclinical airflow obstruction (SAO) and to develop a probability score for SAO to inform potential detection and prevention programs. Lung function and clinical data were harmonized and pooled across nine U.S. general population cohorts. Adults with respiratory symptoms, inhaler use, or prior diagnosis of COPD or asthma were excluded. A probability score for prevalent SAO (forced expiratory volume in 1 second/forced vital capacity < 0.70) was developed via hierarchical group-lasso regularization from clinical variables in strata of sex and smoking status, and its discriminative accuracy for SAO was assessed in the pooled cohort as well as in an external validation cohort (NHANES [National Health and Nutrition Examination Survey] 2011-2012). Incident hospitalizations and deaths due to COPD (respiratory events) were defined by adjudication or administrative criteria in four of nine cohorts. Of 33,546 participants (mean age 52 yr, 54% female, 44% non-Hispanic White), 4,424 (13.2%) had prevalent SAO. The incidence of respiratory events ( = 14,024) was threefold higher in participants with SAO versus those without (152 vs. 39 events/10,000 person-years). The probability score, which was based on six commonly available variables (age, sex, race and/or ethnicity, body mass index, smoking status, and smoking pack-years) was well calibrated and showed excellent discrimination in both the testing sample (C-statistic, 0.81; 95% confidence interval [CI], 0.80-0.82) and in NHANES (C-statistic, 0.83; 95% CI, 0.80-0.86). Among participants with predicted probabilities ⩾ 15%, 3.2 would need to undergo spirometry to detect one case of SAO. Adults with SAO demonstrate excess respiratory hospitalization and mortality. A probability score for SAO using commonly available clinical risk factors may be suitable for targeting screening and primary prevention strategies.

VL - 19 IS - 8 ER -