title: Relationship between lung function impairment and incidence or recurrence of cardiovascular events in a middle-aged cohort.
abstract: BACKGROUND
  Lung function impairment may be a risk factor for cardiovascular disease (CVD) events.
  
  
  OBJECTIVE
  To determine the relationship between the severity of airflow obstruction based on modified Global Initiative on Obstructive Lung Disease (GOLD) criteria and the prevalence and incidence or recurrence of CVD in a cohort of US adults, aged 45-64 years, from 1987 to 2001.
  
  
  METHODS
  We analysed data from 14 681 adults using logistic regression to determine the cross sectional association between lung function impairment and prevalent CVD at baseline and Cox regression to examine the prospective association of lung function impairment at baseline with CVD over 15 years of follow-up. Models were adjusted for age, sex, race, smoking, comorbid hypertension and diabetes, cholesterol levels and fibrinogen level.
  
  
  RESULTS
  At baseline, the crude prevalence of CVD was higher among subjects with GOLD 2 (OR 2.9, 95% CI 2.4 to 3.6) and GOLD 3 or 4 chronic obstructive pulmonary disease (COPD) (OR 3.0, 95% CI 2.0 to 4.5), compared with normal subjects. These relative risks were greatly reduced after adjusting for covariates (OR 1.4, 95% CI 1.1 to 1.8 for GOLD 2 and OR 1.3, 95% CI 0.8 to 2.1 for GOLD 3 or 4). Similarly, the association between COPD and risk of incident or recurrent CVD was much stronger in the unadjusted models (hazard ratio (HR) 2.4, 95% CI 2.1 to 2.7 for GOLD 2 and 2.9, 95% CI 2.2 to 3.9 for GOLD 3 or 4) than in the adjusted ones (HR 1.2, 95% CI 1.03 to 1.4 for GOLD 2 and 1.5, 95% CI 1.1 to 2.0 for GOLD 3 or 4).
  
  
  CONCLUSIONS
  We observed a crude association between lung function impairment and prevalent and incident or recurrent CVD that was greatly reduced after adjusting for covariates, including age, sex, race, smoking, comorbid hypertension and diabetes, cholesterol levels and fibrinogen level. These data suggest that this association may be, in part, mediated through established CVD risk factors included in our adjusted models.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Kentucky Medical Center, 800 Rose Street, MN 614, Lexington, KY 40536, USA.
authors.forename: A K
authors.initials: AK
authors.lastname: Johnston
authors.forename: D M
authors.initials: DM
authors.lastname: Mannino
authors.forename: G W
authors.initials: GW
authors.lastname: Hagan
authors.forename: K J
authors.initials: KJ
authors.lastname: Davis
authors.forename: V A
authors.initials: VA
authors.lastname: Kiri
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology; D004812:Epidemiologic Methods; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology; D012008:Recurrence; D014797:Vital Capacity / Q000502:physiology