Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Airflow obstruction and reduced lung function increase the risk of heart failure

27.02.2012
Low spirometry readings are 'strongly predictive'
Sophia Antipolis, 25 February 2012: A large population-based study has found that lung function and obstructive airway diseases are strongly and independently associated with increased risk of heart failure. Importantly, say the investigators, this association was even evident in never-smokers and was still evident after adjustment for smoking status and number of years smoking. This, they add, indicates "that our results are not primarily confounded by smoking".

Heart failure is by far the single biggest reason for acute hospital admission. Around 30 million people in Europe have heart failure and its incidence is still increasing: more cases are being identified, more people are living to an old age, and more are surviving a heart attack (but with damage to the heart muscle).

The latest study, published on Friday 25 February 2012 in the European Journal of Heart Failure, found that the long-term risk of developing heart failure increased with reduced lung function as measured by forced expiratory volume (FEV1) by spirometry, findings which were not altered by age, prior heart disease, or cardiovascular risk factors (including smoking).(1) The results were derived from the Atherosclerosis Risk in Communities (ARIC) study, a population-based cohort from the USA, funded by the National Heart, Lung and Blood Institute (NHLBI), part of the National Institutes of Health, in which almost 16,000 adults aged 45 - 64 years were followed for an average of 15 years.

The investigators acknowledge that chronic obstructive pulmonary disease (COPD) is a common co-morbidity in patients with heart failure, and vice versa. However, not until very recently has prior COPD been shown as a long-term risk factor for heart failure. Indeed, an editorial accompanying the report says that the study now "strengthens the hypothesis that pulmonary obstruction itself is a major risk factor for heart failure".(2)

The editorial goes on to say that "thinking of heart failure as a possible cause in any patient with shortness of breath and fatigue, or an increase in such symptoms, irrespective of other disease labels, including COPD, means that physicians need to ‘reset’ their clinical reasoning", and reconsider their pharmacological management.

Baseline data of the ARIC cohort was collected between 1987 and 1989 and included information on socioeconomic indicators, medical history, family history, cardiovascular risk factors, serum chemistries, ECGs, medication use, and lung volumes. Three re-examinations followed the baseline visit, as well as annual telephone interviews and active surveillance of hospitalisations and death. Incident heart failure was ascertained from hospital records and death certificates up to 2005 in 13,660 eligible subjects.

Hazard ratios for heart failure, which were calculated according to quartiles of FEV1 in both men and women and adjusted for age, smoking and height, increased steadily over descending quartiles of FEV1. After further adjustment for CVD risk factors, the hazard ratio for heart failure comparing the lowest with the highest quartile FEV1 was 3.91 for white women, 3.03 for white men, 2.11 for black women, and 2.23 for black men. These associations were seen at all levels of smoking.

Thus, the investigators advise that a low FEV1 reading by spirometry "was strongly predictive" of heart failure, independent of other CVD risk markers.

The study's first author, Dr Sunil Agarwal from the University of North Carolina, Chapel Hill, USA, said that the results, when interpreted in the context of existing scientific evidence, support a temporal relationship between low lung capacity and development of heart failure. "This risk”, he added, "given a low FEV1, is similar in magnitude - and may be stronger - than that seen for common and modifiable risk factors such as diabetes or hypertension. The public health implications are huge, particularly since smoking and air pollution affect lung function adversely. So it will be important to determine whether interventions that sustain or improve FEV1 are associated with lower risk of heart failure."

Dr Agarwal noted "multiple drivers" (such as genetic or environmental factors) as a potential explanation for the association. Smoking is known to be associated with heart failure, although in this study the association with low FEV1 was also present in never-smokers. He added that a recent study by Barr et al, published in the New England Journal of Medicine, showed an association between subclinical emphysema with impaired relaxation of the heart, a process which may contribute to the development of heart failure. (3) "Whether pulmonary shunting of blood due to COPD, pulmonary hypertension or arrhythmias also drive this association remains unclear at this time," he said.

"Our study does add to a growing literature indicating that COPD or low FEV1 influence one’s risk of heart failure, even if the observed association cannot be equated with causation. So we have to focus on interventions to prevent or reverse COPD or improve FEV1, and to test whether such interventions reduce the risk of heart failure. Given the complex interaction between the respiratory and cardio-circulatory functions, causation will be hard to disentangle."

Commenting on the patient management implications of the study, Dr Gerardo Heiss, the study's senior investigator, said: "COPD is common in patients with heart failure, but we cannot infer from our results that screening for COPD will reduce the risk of heart failure, or that managing COPD in heart failure patients will improve outcomes. However, our results should add to the growing awareness among practitioners that patients with COPD do have a higher risk of heart failure, and that shortness of breath or impaired vigour should not be ascribed prima facie to COPD without careful consideration of the presence of heart failure."

Notes for editors

1. Agarwal SK, Heiss G, Barr RG, et al. Airflow obstruction, lung function and risk of incident heart failure: The atherosclerosis risk in communities (ARIC) study. Eur J Heart Fail 2012; doi:10.1093/eurjhf/hfs016

2. Rutten FH, Hoes, AW. Chronic obstructive pulmonary disease: a slowly progressive cardiovascular disease masked by its pulmonary effects? Eur J Heart Fail 2012; doi:10.1093/eurjhf/hfs022

3. Barr RG, Bluemke DA, Ahmed FS, et al. Percent emphysema, airflow obstruction, and impaired left ventricular filling. N Engl J Med 2010; 362: 217-227.

* The main symptoms of heart failure are breathlessness (dyspnoea), tiredness and weakness, and oedema (swelling in the legs and ankles).

The European Journal of Heart Failure is a journal of the European Society of Cardiology.It is published on behalf of the ESC by Oxford Journals, a division of Oxford University Press. Please acknowledge the journal as a source in any articles.

About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 71,200 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe. http://www.escardio.org/

More information on this press release, contact details and a PDF of the paper are available from the ESC’s press office press@escardio.org

ESC Press Office | EurekAlert!
Further information:
http://www.escardio.org

More articles from Studies and Analyses:

nachricht Study relating to materials testing Detecting damages in non-magnetic steel through magnetism
23.07.2018 | Technische Universität Kaiserslautern

nachricht Innovative genetic tests for children with developmental disorders and epilepsy
11.07.2018 | Christian-Albrechts-Universität zu Kiel

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Future electronic components to be printed like newspapers

A new manufacturing technique uses a process similar to newspaper printing to form smoother and more flexible metals for making ultrafast electronic devices.

The low-cost process, developed by Purdue University researchers, combines tools already used in industry for manufacturing metals on a large scale, but uses...

Im Focus: First evidence on the source of extragalactic particles

For the first time ever, scientists have determined the cosmic origin of highest-energy neutrinos. A research group led by IceCube scientist Elisa Resconi, spokesperson of the Collaborative Research Center SFB1258 at the Technical University of Munich (TUM), provides an important piece of evidence that the particles detected by the IceCube neutrino telescope at the South Pole originate from a galaxy four billion light-years away from Earth.

To rule out other origins with certainty, the team led by neutrino physicist Elisa Resconi from the Technical University of Munich and multi-wavelength...

Im Focus: Magnetic vortices: Two independent magnetic skyrmion phases discovered in a single material

For the first time a team of researchers have discovered two different phases of magnetic skyrmions in a single material. Physicists of the Technical Universities of Munich and Dresden and the University of Cologne can now better study and understand the properties of these magnetic structures, which are important for both basic research and applications.

Whirlpools are an everyday experience in a bath tub: When the water is drained a circular vortex is formed. Typically, such whirls are rather stable. Similar...

Im Focus: Breaking the bond: To take part or not?

Physicists working with Roland Wester at the University of Innsbruck have investigated if and how chemical reactions can be influenced by targeted vibrational excitation of the reactants. They were able to demonstrate that excitation with a laser beam does not affect the efficiency of a chemical exchange reaction and that the excited molecular group acts only as a spectator in the reaction.

A frequently used reaction in organic chemistry is nucleophilic substitution. It plays, for example, an important role in in the synthesis of new chemical...

Im Focus: New 2D Spectroscopy Methods

Optical spectroscopy allows investigating the energy structure and dynamic properties of complex quantum systems. Researchers from the University of Würzburg present two new approaches of coherent two-dimensional spectroscopy.

"Put an excitation into the system and observe how it evolves." According to physicist Professor Tobias Brixner, this is the credo of optical spectroscopy....

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Leading experts in Diabetes, Metabolism and Biomedical Engineering discuss Precision Medicine

13.07.2018 | Event News

Conference on Laser Polishing – LaP: Fine Tuning for Surfaces

12.07.2018 | Event News

11th European Wood-based Panel Symposium 2018: Meeting point for the wood-based materials industry

03.07.2018 | Event News

 
Latest News

The Maturation Pattern of the Hippocampus Drives Human Memory Deve

23.07.2018 | Science Education

FAU researchers identify Parkinson's disease as a possible autoimmune disease

23.07.2018 | Health and Medicine

O2 stable hydrogenases for applications

23.07.2018 | Life Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>