|Better lung health may portend better heart health, UNC study suggests|
|April 10, 2012|
A large population-based study has found that lung function and obstructive airway diseases are strongly and independently associated with heart failure. Importantly, say the investigators, the association was evident in never-smokers and still evident after adjustment for smoking status and cigarette-years of smoking.
The study, published online Feb. 25 in the European Journal of Heart Failure, was led by UNC Gillings School of Global Public Health alumnus Sunil K. Agarwal, MD, PhD, now with the University of Pittsburgh Medical Center.
The study found that long-term risk of developing heart failure increased with reduced lung function, findings that were not altered by age, prior heart disease or cardiovascular risk factors, including tobacco smoking. The results were drawn from the Atherosclerosis Risk in Communities (ARIC) study, a population-based cohort in the U.S. funded by the National Heart, Lung and Blood Institute, part of the National Institutes of Health, in which nearly 16,000 adults ages 45 to 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. Only recently, however, has prior COPD been shown as a long-term risk factor for heart failure. 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."
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 pharmacological management.
Baseline data of the ARIC cohort were 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 hospitalizations and death. Incident heart failure was ascertained from hospital records and death certificates up to 2005 in 13,660 eligible subjects.
Co-authors from UNC include Gerardo Heiss, MD, PhD, Kenan Distinguished Professor of epidemiology, who was Agarwal's adviser at UNC; Patricia P. Chang, MD, adjunct associate professor of epidemiology in the public health school and associate professor of medicine in the School of Medicine; Laura R. Loehr, PhD, research assistant professor of epidemiology and clinical assistant professor of medicine; Lloyd E. Chambless, PhD, professor of epidemiology (retired); and Wayne Rosamond, PhD, professor of epidemiology.
Co-authors from other universities include R. Graham Barr, MD, DrPH (Columbia University), Eyal Shahar, MD, MPH (University of Arizona-Tucson) and Dalane W. Kitzman, MD (Wake Forest University School of Medicine).
|Last updated April 11, 2012|