Preserved Ratio Impaired Spirometry in Relationship to Cardiovascular Outcomes

BackgroundPreserved ratio impaired spirometry (PRISm) findings are a heterogeneous condition characterized by a normal FEV1 to FVC ratio with underlying impairment of pulmonary function. Data relating to the association of baseline and trajectories of PRISm findings with diverse cardiovascular outcomes are sparse.Research QuestionHow do baseline and trajectories of PRISm findings impact subsequent cardiovascular events?Study Design and MethodsIn the UK Biobank cohort study, we included participants free of cardiovascular disease (CVD) with spirometry (FEV1 and FVC values) at baseline (2006-2010). Participants with baseline spirometry and follow-up spirometry (2014-2020) were included in the lung function trajectory analysis. Cox proportional hazards multivariate regression was performed to evaluate the outcomes of major adverse cardiovascular events (MACEs), incident myocardial infarction (MI), stroke, heart failure (HF), and CVD mortality in association with lung function.ResultsFor baseline analysis (329,954 participants), the multivariate adjusted hazard ratios (HRs) for participants had PRISm findings (vs normal spirometry findings) were 1.26 (95% CI, 1.17-1.35) for MACE, 1.12 (95% CI, 1.01-1.25) for MI, 1.88 (95% CI, 1.72-2.05) for HF, 1.26 (95% CI, 1.13-1.40) for stroke, and 1.55 (95% CI, 1.37-1.76) for CVD mortality, respectively. A total of 22,781 participants underwent follow-up spirometry after an average of 8.9 years. Trajectory analysis showed that persistent PRISm findings (HR, 1.96; 95% CI, 1.24-3.09) and airflow obstruction (HR, 1.43; 95% CI, 1.00-2.04) was associated with a higher incidence of MACE vs consistently normal lung function. Compared with persistent PRISm findings, changing from PRISm to normal spirometry findings was associated with a lower incidence of MACE (HR, 0.42; 95% CI, 0.19-0.99).InterpretationIndividuals with baseline or persistent PRISm findings were at a higher risk of diverse cardiovascular outcomes even after adjusting for a wide range of confounding factors. However, individuals who transitioned from PRISm to normal findings showed a similar cardiovascular risk as those with normal lung function. Preserved ratio impaired spirometry (PRISm) findings are a heterogeneous condition characterized by a normal FEV1 to FVC ratio with underlying impairment of pulmonary function. Data relating to the association of baseline and trajectories of PRISm findings with diverse cardiovascular outcomes are sparse. How do baseline and trajectories of PRISm findings impact subsequent cardiovascular events? In the UK Biobank cohort study, we included participants free of cardiovascular disease (CVD) with spirometry (FEV1 and FVC values) at baseline (2006-2010). Participants with baseline spirometry and follow-up spirometry (2014-2020) were included in the lung function trajectory analysis. Cox proportional hazards multivariate regression was performed to evaluate the outcomes of major adverse cardiovascular events (MACEs), incident myocardial infarction (MI), stroke, heart failure (HF), and CVD mortality in association with lung function. For baseline analysis (329,954 participants), the multivariate adjusted hazard ratios (HRs) for participants had PRISm findings (vs normal spirometry findings) were 1.26 (95% CI, 1.17-1.35) for MACE, 1.12 (95% CI, 1.01-1.25) for MI, 1.88 (95% CI, 1.72-2.05) for HF, 1.26 (95% CI, 1.13-1.40) for stroke, and 1.55 (95% CI, 1.37-1.76) for CVD mortality, respectively. A total of 22,781 participants underwent follow-up spirometry after an average of 8.9 years. Trajectory analysis showed that persistent PRISm findings (HR, 1.96; 95% CI, 1.24-3.09) and airflow obstruction (HR, 1.43; 95% CI, 1.00-2.04) was associated with a higher incidence of MACE vs consistently normal lung function. Compared with persistent PRISm findings, changing from PRISm to normal spirometry findings was associated with a lower incidence of MACE (HR, 0.42; 95% CI, 0.19-0.99). Individuals with baseline or persistent PRISm findings were at a higher risk of diverse cardiovascular outcomes even after adjusting for a wide range of confounding factors. However, individuals who transitioned from PRISm to normal findings showed a similar cardiovascular risk as those with normal lung function. Take-home PointsStudy Question: What are the associations between baseline and trajectories of preserved ratio impaired spirometry (PRISm) findings and subsequent cardiovascular events? Do individuals who transition from PRISm to normal findings show similar prognosis as those with persistent normal lung function?Results: In the general population, individuals with baseline PRISm and persistent PRISm findings and those who demonstrate PRISm findings after normal lung function experience an increased risk of cardiovascular events, but individuals who transition from PRISm to normal findings show similar risk as those with normal lung function.Interpretation: These results suggest that PRISm findings are an important subtype of spirometry categories related to the risks of diverse cardiovascular events and that individuals who transition from PRISm to normal findings show similar cardiovascular risk as those with normal lung function. Study Question: What are the associations between baseline and trajectories of preserved ratio impaired spirometry (PRISm) findings and subsequent cardiovascular events? Do individuals who transition from PRISm to normal findings show similar prognosis as those with persistent normal lung function? In the general population, individuals with baseline PRISm and persistent PRISm findings and those who demonstrate PRISm findings after normal lung function experience an increased risk of cardiovascular events, but individuals who transition from PRISm to normal findings show similar risk as those with normal lung function. 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These results suggest the of PRISm findings, a or lung function and the of lung function are to the underlying the association between PRISm findings and cardiovascular and the of PRISm findings trajectories are was by the of the for the of the and the of the of and the and