Korean Circ J.  2011 Apr;41(4):171-174. 10.4070/kcj.2011.41.4.171.

Evidence of Lung Function for Stratification of Cardiovascular Disease Risk

• Lee HM
• Truong ST
• Wong ND

• KMID: 2028939
• DOI: http://doi.org/10.4070/kcj.2011.41.4.171

Abstract

Among adults in the United States, the prevalence of reduced lung function including obstructive and restrictive lung disease is about 20%, representing an over 40 million adults. Persons with reduced lung function often demonstrate chronic systemic inflammation, such as from elevated levels of C-reactive protein. Substantial data suggests that inflammation may have a significant role in the association between reduced lung function and cardiovascular disease (CVD); however, how reduced lung function predicts CVD as risk modification remains largely unknown. Poor lung function has been shown to be a better predictor of all-cause and cardiac-specific mortality than established risk factors such as serum cholesterol, and CVD is the leading cause of mortality among those with impaired lung function. The exact mechanism of atherosclerosis is not clear, but persistent low grade inflammation is considered as one of the culprits in clot formation. The initial presentation of coronary heart disease is either myocardial infarction or sudden death in approximately half of the individuals. Unfortunately, conventional risk factor assessment predicts only 65-80% of future cardiovascular events, leaving many middle-aged and older individuals to manifest a major cardiovascular event despite being classified low risk by the Framingham risk estimates.

Keyword

Respiratory function test

MeSH Terms

Adult
Atherosclerosis
C-Reactive Protein
Cardiovascular Diseases
Cholesterol
Coronary Disease
Death, Sudden
Humans
Inflammation
Lung
Lung Diseases
Myocardial Infarction
Prevalence
Respiratory Function Tests
Risk Factors
United States
C-Reactive Protein
Cholesterol

Reference

1. Gluckman TJ, Baranowski B, Ashen MD, et al. A practical and evidence-based approach to cardiovascular disease risk reduction. Arch Intern Med. 2004. 164:1490–1500.

2. D'Agostino RB Sr, Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008. 117:743–753.

3. Thompson JB, Rivera JJ, Blumenthal RS, Danyi P. Primary prevention for patients with intermediate Framingham risk scores. Curr Cardiol Rep. 2006. 8:261–266.

4. Berk BC, Weintraub WS, Alexander RW. Elevation of C-reactive protein in "active" coronary artery disease. Am J Cardiol. 1990. 65:168–172.

5. Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003. 107:363–369.

6. Wilson PW, Smith SC Jr, Blumenthal RS, Burke GL, Wong ND. 34^th Bethesda conference task force #4: how do we select patients for atherosclerosis imaging? J Am Coll Cardiol. 2003. 41:1898–1906.

7. Greenland P, Bonow RO, Brundage BH, et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA writing committee to update the 2000 expert consensus document on electron beam computed tomography) developed in collaboration with the society of atherosclerosis imaging and prevention and the society of cardiovascular computed tomography. J Am Coll Cardiol. 2007. 49:378–402.

8. Wilson PW, Pencina M, Jacques P, Selhub J, D'Agostino R Sr, O'Donnell CJ. C-reactive protein and reclassification of cardiovascular risk in the Framingham Heart Study. Circ Cardiovasc Qual Outcomes. 2008. 1:92–97.

9. Greenland P, Alpert JS, Beller GA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: assessment of cardiovascular risk in asymptomatic adults. J Am Coll Cardiol. 2010. 56:e50–e103. doi: 10.1016/j.jacc.2010.09.001.

10. Libby P. Inflammation in atherosclerosis. Nature. 2002. 420:868–874.

11. Nilsson J. CRP: marker or marker of cardiovascular disease? Arterioscler Thromb Vasc Biol. 2005. 25:1527–1528.

12. Scirica BM, Morrow DA. Is C-reactive protein an innocent bystander or proatherogenic culprit? The verdict is still out. Circulation. 2006. 113:2128–2134. discussion 2151.

13. Kannel WB, Hubert H, Lew EA. Vital capacity as a predictor of cardiovascular disease: the Framingham Study. Am Heart J. 1983. 105:311–315.

14. Marcus EB, Curb JD, MacLean CJ, Reed DM, Yano K. Pulmonary function as a predictor of coronary heart disease. Am J Epidemiol. 1989. 129:97–104.

15. Engström G, Lind P, Hedblad B, et al. Lung function and cardiovascular risk: relationship with inflammation-sensitive plasma proteins. Circulation. 2002. 106:2555–2560.

16. Schroeder EB, Welch VL, Couper D, et al. Lung function and incident coronary heart disease: the Atherosclerosis Risk in Communities Study. Am J Epidemiol. 2003. 158:1171–1181.

17. Sin DD, Wu L, Man SF. The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature. Chest. 2005. 127:1952–1959.

18. Higgins MW, Keller JB. Predictors of mortality in the adult population of Tecumseh. Arch Environ Health. 1970. 21:418–424.

19. Beaty TH, Newill CA, Cohen BH, Tockman MS, Bryant SH, Spurgeon HA. Effects of pulmonary function on mortality. J Chronic Dis. 1985. 38:703–710.

20. Tockman MS, Comstock GW. Respiratory risk factors and mortality: longitudinal studies in Washington county, Maryland. Am Rev Respir Dis. 1989. 140:S56–S63.

21. Hole DJ, Watt GC, Darvey-Smith G, Hart CL, Gillis CR, Hawthorne VM. Impaired lung function and mortality risks in men and women: findings from the Renfrew and Paisley prospective population study. BMJ. 1996. 313:711–715.

22. Schünemann HJ, Dorn J, Grant BJ, Winkelstein W Jr, Trevisan M. Pulmonary function is a long term predictor of mortality in the general population: 29-year follow-up of the Buffalo Health Study. Chest. 2000. 118:656–664.

23. Curb JD, Marcus EB, Reed DM, MacLean C, Yano K. Smoking, pulmonary function and mortality. Ann Epidemiol. 1990. 1:25–32.

24. Lange P, Nyboe J, Appleyard M, Jensen G, Schnohr P. Spirometric findings and mortality in never smokers. J Clin Epidemiol. 1990. 43:867–873.

25. Sin DD, Man SF. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular disease? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation. 2003. 107:1514–1519.

26. Lee HM, Le H, Lee BT, Lopez VA, Wong ND. Forced vital capacity paired with Framingham risk score for prediction of all-cause mortality. Eur Respir J. 2010. 36:1002–1006.

27. Jiang R, Burke GL, Enright PL, et al. Inflammatory markers and longitudinal lung function decline in the elderly. Am J Epidemiol. 2008. 168:602–610.

28. Thyagarajan B, Jacobs DR, Apostol GG, Smith LJ, Lewis CE, Williams OD. Plasma fibrinogen and lung function: the CARDIA Study. Int J Epidemiol. 2006. 35:1001–1008.

29. Hancox RJ, Poulton R, Greene JM, et al. Systemic inflammation and lung function in young adults. Thorax. 2007. 62:1064–1068.

30. Shaaban R, Kony S, Driss F, et al. Change in C-reactive protein levels and FEV1 decline: a longitudinal population-based study. Respir Med. 2006. 100:2112–2120.

31. Fogarty AW, Jones S, Britton JR, Lewis SA, McKeever TM. Systemic inflammation and decline in lung function in a general population: a prospective study. Thorax. 2007. 62:515–520.

32. Lee HM, Le TV, Lopez VA, Wong ND. Association of C-reactive protein with reduced forced vital capacity in a nonsmoking U.S. population with metabolic syndrome and diabetes. Diabetes Care. 2008. 31:2000–2002.

33. Gan WQ, Man SF, Senthilsevan A, Sin DD. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax. 2004. 59:574–580.

34. Mannino DM, Ford ES, Redd SC. Obstructive and restrictive lung disease and markers of inflammation: data from the third national health and nutrition examination. Am J Med. 2003. 114:758–762.

35. Mancini GB, Etminan M, Zhang B, Levesque LE, FitzGerald JM, Brophy JM. Reduction of morbidity and mortality by statins, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers in patients with chronic obstructive pulmonary disease. J Am Coll Cardiol. 2006. 47:2554–2560.

36. Søyseth V, Brekke PH, Smith P, Omland T. Statin use is associated with reduced mortality in COPD. Eur Respir J. 2007. 29:279–283.

37. Frost FJ, Petersen H, Tollestrup K, Skipper B. Influenza and COPD mortality protection as pleiotropic, dose-dependent effects of statins. Chest. 2007. 131:1006–1012.

38. Keddissi JI, Younis WG, Chbeir EA, Daher NN, Dernaika TA, Kinasewitz GT. The use of statins and lung function in current and former smokers. Chest. 2007. 132:1764–1771.

39. Mannino DM, Davis KJ. Lung function decline and outcomes in an elderly population. Thorax. 2006. 61:472–477.

40. Mannino DM, Reichert MM, Davis KJ. Lung function decline and outcomes in an adult population. Am J Respir Crit Care Med. 2006. 173:985–990.

41. Janda S, Park K, FitzGerald JM, Etminan M, Swiston J. Statins in COPD: a systemic review. Chest. 2009. 136:734–743.