title: Airflow obstruction, lung function, and risk of incident heart failure: the Atherosclerosis Risk in Communities (ARIC) study.
abstract: OBJECTIVE
  We examined the relationship between forced expiratory volume in 1 s (FEV(1)), airflow obstruction, and incident heart failure (HF) in black and white, middle-aged men and women in four US communities.
  
  
  RESULTS
  Lung volumes by standardized spirometry and information on covariates were collected on 15 792 Atherosclerosis Risk in Communities (ARIC) cohort participants in 1987-89. Incident HF was ascertained from hospital records and death certificates up to 2005 in 13 660 eligible participants. Over an average follow-up of 14.9 years, 1369 (10%) participants developed new-onset HF. The age- and height-adjusted hazard ratios (HRs) for HF increased monotonically over descending quartiles of FEV(1) for both genders, race groups, and smoking status. After multivariable adjustment for traditional cardiovascular risk factors and height, the HRs [95% confidence intervals (CIs)] of HF comparing the lowest with the highest quartile of FEV(1) were 3.91 (2.40-6.35) for white women, 3.03 (2.12-4.33) for white men, 2.11 (1.33-3.34) for black women, and 2.23 (1.37-3.59) for black men. The association weakened but remained statistically significant after additional adjustment for systemic markers of inflammation. The multivariable adjusted incidence of HF was higher in those with FEV(1)/forced vital capacity <70% vs. ≥70%: HR 1.44 (95% CI 1.20-1.74) among men and 1.40 (1.13-1.72) among women. A consistent and positive association with HF was seen for self-reported diagnosis of emphysema and chronic obstructive pulmonary disease, but not for asthma.
  
  
  CONCLUSIONS
  In this large population-based cohort with long-term follow-up, low FEV(1) and an obstructive respiratory disease were strongly and independently associated with the risk of incident HF.
authors.affiliation: Department of Epidemiology, University of North Carolina, 137 E. Franklin Street, Chapel Hill, NC 27514, USA. sunilagarwal@unc.edu
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Agarwal
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
authors.forename: R Graham
authors.initials: RG
authors.lastname: Barr
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Chang
authors.forename: Laura R
authors.initials: LR
authors.lastname: Loehr
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Chambless
authors.forename: Eyal
authors.initials: E
authors.lastname: Shahar
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
mesh_terms: D015897:Comorbidity; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000473:pathology*; D005260:Female; D006333:Heart Failure / Q000473:pathology*; D006801:Humans; D015994:Incidence; D008168:Lung / Q000473:pathology* / Q000502:physiology; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018384:Oxidative Stress; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000473:pathology; D012129:Respiratory Function Tests; D018570:Risk Assessment; D057566:Self Report