A Lower Level of Forced Expiratory Volume in 1 Second Is a Risk Factor for All-Cause and Cardiovascular Mortality in a Japanese Population: The Takahata Study

Abstract

Chronic obstructive pulmonary disease is a known risk factor for cardiovascular death in Western countries. Because Japan has a low cardiovascular death rate, the association between a lower level of forced expiratory volume in 1 s (FEV1) and mortality in Japan’s general population is unknown. To clarify this, we conducted a community-based longitudinal study. This study included 3253 subjects, who received spirometry from 2004 to 2006 in Takahata, with a 7-year follow-up. The causes of death were assessed on the basis of the death certificate. In 338 subjects, airflow obstruction was observed by spirometry. A total of 127 subjects died. Cardiovascular death was the second highest cause of death in this population. The pulmonary functions of the deceased subjects were significantly lower than those of the subjects who were alive at the end of follow-up. The relative risk of death by all causes, respiratory failure, lung cancer, and cardiovascular disease was significantly increased with airflow obstruction. The Kaplan–Meier analysis showed that all-cause and cardiovascular mortality significantly increased with a worsening severity of airflow obstruction. After adjusting for possible factors that could influence prognosis, a Cox proportional hazard model analysis revealed that a lower level of FEV1 was an independent risk factor for all-cause and cardiovascular mortality (per 10% increase; hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.82–0.98; and HR, 0.72; 95% CI, 0.61–0.86, respectively). In conclusion, airflow obstruction is an independent risk factor for all-cause and cardiovascular death in the Japanese general population. Spirometry might be a useful test to evaluate the risk of cardiovascular death and detect the risk of respiratory death by lung cancer or respiratory failure in healthy Japanese individuals.

Exercise testing and spirometry as predictors of mortality in congenital heart disease: Contrasting Fontan physiology with repaired tetralogy of Fallot

“…In a study of adults ≥40 years of age, the proportion of patients at high risk for cardiovascular events was twice as high among patients with FEV 1 <80% predicted compared to those with normal FEV 1 measurements . A low FVC and/or FEV 1 have also been found to be associated with increased cardiovascular mortality in other studies, and in a systematic meta‐analytic review of the literature …”

“…The mechanisms responsible for the relationship between spirometric measurements and mortality in TOF and Fontan patients remain undefined. Past investigators, when noting a correlation between spirometric abnormalities and cardiovascular risk in the general population, have speculated that abnormal spirometric measurements reflect the presence of COPD which is, at least in part, an inflammatory disease process that may affect the cardiovascular system as well as the lungs . This explanation, initially proposed for patients with acquired heart disease, may apply to Fontan and TOF patients as well.…”

A lower level of forced expiratory volume in one second predicts the poor prognosis of small cell lung cancer

“…We used Pearson's chi-squared tests to compare discrete 239 SCLC patients 170 SCLC patients 69 subjects excluded for: Death during work up [4] Untreated [24] Transfre [22] Omitted PFT record [19] 94 ED 76 LD …”

“…A reduced FEV 1 is not only the marker of severity of COPD but also a predictor of increased risk of lung cancer, cardiovascular disease and premature death from all causes in the general population (17)(18)(19). In patients with lung cancer, a reduced FEV 1 was strongly associated with mortality in advanced NSCLC and a low predicted postoperative FEV 1 was related to mortality in completely resected NSCLC (11,20).…”

Should we use gait speed in COPD, FEV1in frailty and dyspnoea in both?

“…Forced expiratory volume in 1 s (FEV1) is an independent predictor of all-cause and CVD mortality [26][27][28][29][30]. The addition of global CVD risk scores to lung function data significantly improves risk stratification of patients with COPD for CVD and total mortality [31].…”