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Lung function link to heart risk

Lung function and obstructive airway diseases are strongly and independently associated with increased risk of heart failure, according to a large population-based study published recently in the European Journal of Heart Failure.1

The results were derived from the Atherosclerosis Risk in Communities (ARIC) study, a population-based cohort from the USA, which followed almost 16,000 adults aged 45–64, for an average of 15 years.  The study found that the long-term risk of developing heart failure increased with reduced lung function as measured by forced expiratory volume (FEV1) by spirometry, findings which were not altered by age, prior heart disease, or cardiovascular risk factors.

Importantly, say the investigators, this association was even evident in never-smokers and was still evident after adjustment for smoking status and number of years smoking. This, they add, indicates “that our results are not primarily confounded by smoking”.

The study’s first author Dr Sunil Agarwal (University of North Carolina, USA) said that the results support a link between low lung capacity and development of heart failure. “This risk”, he added, “given a low FEV1, is similar in magnitude – and may be stronger – than that seen for common and modifiable risk factors such as diabetes or hypertension. The public health implications are huge, particularly since smoking and air pollution affect lung function adversely. So it will be important to determine whether interventions that sustain or improve FEV1 are associated with lower risk of heart failure”.

iStock_000003941859XSmall“Our study does add to a growing literature indicating that chronic obstructive pulmonary disease (COPD) or low FEV1 influence one’s risk of heart failure, even if the observed association cannot be equated with causation. So we have to focus on interventions to prevent or reverse COPD or improve FEV1, and to test whether such interventions reduce the risk of heart failure. Given the complex interaction between the respiratory and cardio-circulatory functions, causation will be hard to disentangle.”

The investigators acknowledge that COPD is a common co-morbidity in patients with heart failure, and vice versa. In an accompanying editorial, Drs Frans H Rutten and Arno W Hoes say that the study now “strengthens the hypothesis that pulmonary obstruction itself is a major risk factor for heart failure”.2

They go on to say that “thinking of heart failure as a possible cause in any patient with shortness of breath and fatigue, or an increase in such symptoms, irrespective of other disease labels, including COPD, means that physicians need to ‘reset’ their clinical reasoning”, and reconsider their pharmacological management.

Dr Gerardo Heiss, the study’s senior investigator, said: “COPD is common in patients with heart failure, but we cannot infer from our results that screening for COPD will reduce the risk of heart failure, or that managing COPD in heart failure patients will improve outcomes. However, our results should add to the growing awareness among practitioners that patients with COPD do have a higher risk of heart failure, and that shortness of breath or impaired vigour should not be ascribed prima facie to COPD without careful consideration of the presence of heart failure”.

Reference

1. Agarwal SK, Heiss G, Barr RG, et al. Airflow obstruction, lung function and risk of incident heart failure: the atherosclerosis risk in communities (ARIC) study. Eur J Heart Fail 2012. doi:10.1093/eurjhf/hfs016 


2. Rutten FH, Hoes AW. Chronic obstructive pulmonary disease: a slowly progressive cardiovascular disease masked by its pulmonary effects? Eur J Heart Fail 2012. doi:10.1093/eurjhf/hfs022

Published on: March 9, 2012

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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