title: Lung function, insulin resistance and incidence of cardiovascular disease: a longitudinal cohort study.
abstract: OBJECTIVE
  To explore whether a reduced lung function is a risk factor for developing diabetes and insulin resistance (IR), and whether such relationship contributes to the largely unexplained association between lung function and incidence of cardiovascular disease (CVD).
  
  
  METHODS
  Forced vital capacity (FVC) was assessed at baseline. Incidence of diabetes and IR [according to the homeostasis model assessment (HOMA) model] was assessed in a follow-up examination after 13.9 +/- 2.6 and 9.4 +/- 3.6 years for men and women, respectively. After the follow-up examination, incidence of CVD (stroke, myocardial infarction or cardiovascular death) was monitored over 7 years.
  
  
  METHODS
  Populations-based cohort study.
  
  
  METHODS
  Initially nondiabetic men (n = 1436, mean age 44.6 years) and women (n = 896, mean age 49.8 years).
  
  
  RESULTS
  Prevalence of IR at the follow-up examination was 34, 26, 21 and 21%, respectively, for men in the first (lowest), second, third and fourth quartile of baseline FVC (P for trend <0.0001). The corresponding values for women were 30, 29, 25 and 17%, respectively (P for trend <0.001). Adjusted for potential confounders, the odds ratio (OR) for IR (per 10% increase in FVC) was 0.91 (CI: 0.84-0.99) for men and 0.89 (CI: 0.80-0.98) for women. FVC was similarly significantly associated with the incidence of diabetes (OR = 0.90, CI: 0.81-1.00), adjusted for sex and other confounders. The incidence of CVD after the follow-up examination was significantly increased only amongst subjects with low FVC who had developed IR (RR = 1.7, CI: 1.02-2.7).
  
  
  CONCLUSIONS
  Subjects with a moderately reduced FVC have an increased risk of developing IR and diabetes. This relationship seems to contribute to the largely unexplained association between reduced lung function and incidence of CVD.
authors.affiliation: Department of Community Medicine, University of Lund, Malmö University Hospital, Malmö, Sweden. gunnar.engstrom@smi.mas.lu.se
authors.forename: G
authors.initials: G
authors.lastname: Engström
authors.forename: B
authors.initials: B
authors.lastname: Hedblad
authors.forename: P
authors.initials: P
authors.lastname: Nilsson
authors.forename: P
authors.initials: P
authors.lastname: Wollmer
authors.forename: G
authors.initials: G
authors.lastname: Berglund
authors.forename: L
authors.initials: L
authors.lastname: Janzon
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac; D003925:Diabetic Angiopathies / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008137:Longitudinal Studies; D008171:Lung Diseases / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D020521:Stroke / Q000209:etiology; D014797:Vital Capacity