title: Lung function and heart disease in American Indian adults with high frequency of metabolic abnormalities (from the Strong Heart Study).
abstract: The associations of pulmonary function with cardiovascular disease (CVD) independent of diabetes mellitus (DM) and metabolic syndrome have not been examined in a population-based setting. We examined prevalence and incidence CVD in relation to lower pulmonary function in the Strong Heart Study second examination (1993 to 1995) in 352 CVD and 2,873 non-CVD adults free of overt lung disease (mean age 60 years). Lung function was assessed by standard spirometry. Participants with metabolic syndrome or DM with or without CVD had lower pulmonary function than participants without these conditions after adjustment for hypertension, age, gender, abdominal obesity, smoking, physical activity index, and study field center. CVD participants with DM had significantly lower forced vital capacity than participants with CVD alone. Significant associations were observed between reduced pulmonary function, preclinical CVD, and prevalent CVD after adjustment for multiple CVD risk factors. During follow-up (median 13.3 years), pulmonary function did not predict CVD incidence, it predicted CVD mortality. Among 3,225 participants, 412 (298 without baseline CVD) died from CVD by the end of 2008. In models adjusted for multiple CVD risk factors, DM, metabolic syndrome, and baseline CVD, compared with highest quartile of lung function, lower lung function predicted CVD mortality (relative risk up to 1.5, 95% confidence interval 1.1 to 2.0, p<0.05). In conclusion, a population with a high prevalence of DM and metabolic syndrome and lower lung function was independently associated with prevalent clinical and preclinical CVD, and its impairment predicted CVD mortality. Additional research is needed to identify mechanisms linking metabolic abnormalities, low lung function, and CVD.
authors.affiliation: Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Electronic address: fawn-yeh@ouhsc.edu.
authors.forename: Fawn
authors.initials: F
authors.lastname: Yeh
authors.affiliation: Pulmonary Disease and Critical Care Medicine Unit, College of Medicine, University of Vermont, Burlington, Vermont.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Dixon
authors.affiliation: Missouri Breaks Industries Research Inc., Timber Lake, South Dakota.
authors.forename: Lyle G
authors.initials: LG
authors.lastname: Best
authors.affiliation: Department of Physical Therapy, University of Delaware, Newark, Delaware.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Marion
authors.affiliation: Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Elisa T
authors.initials: ET
authors.lastname: Lee
authors.affiliation: Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Tauqeer
authors.initials: T
authors.lastname: Ali
authors.affiliation: Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Jeunliang
authors.initials: J
authors.lastname: Yeh
authors.affiliation: Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Everett R
authors.initials: ER
authors.lastname: Rhoades
authors.affiliation: Barbara V. Howard, PhD, MedStar Research Institute, Hyattsville, Maryland.
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.affiliation: Weill Cornell Medical College, New York, New York.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications / Q000208:ethnology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007198:Indians, North American; D008168:Lung / Q000503:physiopathology*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000208:ethnology* / Q000503:physiopathology; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013147:Spirometry; D014481:United States / Q000453:epidemiology; D014797:Vital Capacity