Impact of restrictive lung disorder on cardiovascular mortality in a general population: The Yamagata (Takahata) study
Introduction
Cardio-pulmonary interaction has begun to gather attention as an important therapeutic target in patients with heart and lung diseases. In pathological conditions, the heart and lung have a significant effect on each other because of their anatomical and functional linkages [1]. Lung congestion, cardiac enlargement, pleural effusion, and skeletal muscle fatigue caused by cardiac dysfunction are all known to impair lung function [2], [3]. On the other hand, lung disease causes systemic inflammation [4], hypoxia, sympathetic nervous activation, exercise intolerance [5], pulmonary vascular remodeling and right heart remodeling, which all have a deleterious effect on heart disease [6]. Lung diseases are also reported to worsen clinical outcomes in patients with cardiovascular disease [7], [8], [9], [10].
Chronic obstructive lung disease (COLD) and bronchial asthma are major causes of airflow obstruction in the general population. These obstructive lung disorders (OLDs) have been recognized as significant risk factors for cardiovascular disease [8], [11], [12]. Since a major etiology of OLD is COLD, many OLDs are attributed to cigarette smoking [13]. On the other hand, restrictive lung disorder (RLD) has no clear association with smoking, and includes various etiologies [1], [14], [15]. Due to the miscellaneous nature of RLD, its suspicion and diagnosis is challenging, and the impact of RLD on cardiovascular disease may thus be underestimated. RLD has been shown to be prevalent in patients with cardiovascular diseases [7], [16]. A cross-sectional study reported that the prevalence of ischemic heart disease is higher in subjects with RLD than in those with OLD or normal lung function [17]. Furthermore, coexistence of RLD has been shown to predict worse outcomes in patients with cardiovascular disease [18]. However, it is still unclear whether the presence of RLD is associated with cardiovascular mortality in the general population. The aim of the present study was to elucidate the prevalence of RLD and the impact of RLD on cardiovascular mortality in an apparently healthy, general population.
Section snippets
Study design and subjects
This study was a community-based prospective cohort study that formed part of the molecular epidemiological study utilizing the regional characteristics of a 21st century Centers of Excellence (COE) program and the Global COE program in Japan. Details of the study methodology are reported elsewhere [19], [20]. This study was approved by the ethics committee of Yamagata University School of Medicine and all participants gave written informed consent. The studied subjects were participants in a
Prevalence of lung dysfunction in a general population
There were 262 subjects with OLD (8.1%), 194 subjects with RLD (6.0%), and 73 subjects with mixed lung disorder (2.2%) (Fig. 1A). All lung dysfunctions were increased with advancing age (Fig. 1B). The prevalence of RLD was higher than that of OLD in subjects aged < 60 years. However, the prevalence of OLD increased abruptly, and was 1.79 times higher in subjects aged ≥ 60 years compared with those aged < 60 years.
Characteristics of the study subjects
Table 1 shows the baseline clinical characteristics of the study subjects. Although
Discussion
The major findings of this study were: (1) prevalence of RLD was not negligible, even in apparently healthy subjects without clinical symptoms; (2) multivariate Cox hazard analysis revealed that RLD was an independent risk factor for cardiovascular mortality; and (3) the prediction model including RLD had an improved NRI and IDI.
Conclusions
RLD is prevalent and latent in an asymptomatic general population and is an independent risk factor for cardiovascular mortality in this population. More attention should be paid to the possibility of RLD in general practices.
Conflict of interest
The authors report no relationships that could be construed as a conflict of interest.
Acknowledgements
This study was supported in part by a Grant-in-Aid from the 21st Century of Excellence (COE) and Global COE program of the Japan Society for the Promotion of Science (15K09240).
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