Association between lung function and future risks of diabetes, asthma, myocardial infarction, hypertension and all-cause mortality

Abstract

BackgroundWhile forced expiratory volume in 1 s (FEV1) is a hallmark of disease progression in chronic obstructive lung diseases, little is known about the relationship between baseline FEV1 and future risks of other medical conditions.ObjectiveTo study the association between baseline FEV1 and future risks of diabetes, asthma, myocardial infarction, hypertension and all-cause mortality.MethodsWe used data from the National Health and Nutrition Examination Survey and its Epidemiological Follow-Up Study. Our data provided longitudinal follow-up of the original cohort for up to 12 years. We used two competing risks approaches, the cause-specific hazard model and the Fine-Gray sub-distribution hazard model, to measure the associations between baseline FEV1 and future risks of the outcomes of interest. All models adjusted for major confounding factors.ResultsThe final sample included 3020 participants (mean baseline age: 44.64 years, standard deviation: 13.44). In the cause-specific hazard model, for every percent increase in the baseline percent predicted FEV1, the hazard of the event reduced by 2.5% (HR: 0.975 (95% Confidence Interval [CI]: 0.958, 0.994)) for diabetes, 4.3% (HR: 0.957 (95%CI: 0.932, 0.983)) for asthma, and 1.8% (HR: 0.982 (95%CI: 0.971, 0.992)) for all-cause mortality. There was no statistically significant association between baseline percent predicted FEV1 and future risks of myocardial infarction (HR: 0.987 (95%CI: 0.970, 1.004)) and hypertension (HR: 0.998 (95%CI: 0.992, 1.005)). Consistent results were observed for the Fine-Gray sub-distribution hazard model.ConclusionOur data suggests that lower percent predicted FEV1 values at baseline were significantly associated with higher future risks of diabetes, asthma, and all-cause mortality.

Polygenic scores for low lung function and the future risk of adverse health outcomes

“…The direction of association and mechanisms had remained unclear in the past [36], however there is now emerging evidence for a bi-directional causal association between lung function and diabetes [35]. An association between low vital capacity as a predictor of diabetes has been consistently found in previous observational studies [5,[37][38][39]. The possible explanations for this link have included reduced physical activity due to poor lung function leading to central obesity, hypoxaemia induced insulin resistance, adverse foetal or early-life conditions that effect organogenesis and metabolic pathway programming leading to insulin resistance and inflammation [37].…”

Low lung function in Bipolar Disorder and Schizophrenia: a hidden risk

“…Several longitudinal studies have shown an association between reduced lung volume or abnormal spirometry patterns and increased morbidity and mortality. Reduced FEV1 has been associated with an increased risk of occurrence of respiratory disease (Agusti et al, 2017;Shah et al, 2021) and metabolic abnormalities, including diabetes (Agusti et al, 2017;Shah et al, 2021), heart failure (Ramalho et al, 2022) and cardiovascular events (Agusti et al, 2017;Cuttica et al, 2018), and an increased risk of cardiovascular (Sin et al, 2005) and all-cause mortality (Agusti et al, 2017;Sarycheva et al, 2022). COPD or a reduced FEV1/FVC ratio has been associated with an increased risk of lung cancer (Kaaks (Collaro et al, 2021;Guo et al, 2021;Kaaks et al, 2022).…”

“…Among natural causes, chronic obstructive pulmonary disease (COPD) is one of the highest causes of excess mortality in people with schizophrenia or bipolar disorder, even higher than that of cardiovascular diseases (Saha et al, 2007;Hayes et al, 2015;Olfson et al, 2015;Correll et al, 2022). In the general population, both COPD and spirometrically determined impaired lung function are associated with increased morbidity and mortality (Sin et al, 2005;Guerra et al, 2010;Agusti et al, 2017;Honda et al, 2017;Cuttica et al, 2018;Collaro et al, 2021;Guo et al, 2021;Shah et al, 2021;Kaaks et al, 2022;Ramalho et al, 2022;Sarycheva et al, 2022;Dharmage et al, 2023).…”

Exploring the association between asthma and chronic comorbidities: impact on clinical outcomes

“…Hyperglycemia appears to be intricately linked to impaired lung function, as having a lower forced expiratory volume in 1 s (FEV1) is associated with an increased likelihood of developing DM in the future (126). Moreover, fasting plasma glucose and HbA1c levels exhibit an inverse relationship with lung function test results, indicating the potential impact of glycemic control on respiratory health (127,128).…”