Role of Pulmonary Function in Predicting New-Onset Cardiometabolic Diseases and Cardiometabolic Multimorbidity

Chest. 2022 Aug;162(2):421-432. doi: 10.1016/j.chest.2021.12.663. Epub 2022 Jan 12.


Background: Although pulmonary function has been studied in relationship to individual cardiometabolic diseases, uncertainty persists about the difference in risk magnitudes of pulmonary function for these diseases and its association with cardiometabolic multimorbidity (CM).

Research question: Does pulmonary function have different risk magnitudes for cardiometabolic diseases and CM?

Study design and methods: This study used data from the UK Biobank, including 357,433 individuals with no cardiometabolic diseases at baseline (stage I) and 35,034 individuals with one cardiometabolic disease at baseline (stage II). Pulmonary function was measured by FVC or FEV1. We defined CM as the coexistence of at least two cardiometabolic diseases: type 2 diabetes (T2D), coronary heart disease (CHD), and stroke. Multinomial logistic regression models and Cox proportional hazards models were performed to estimate ORs or hazard ratios (HRs) and their 95% CIs for the longitudinal relationship between baseline pulmonary function and incident cardiometabolic outcomes.

Results: In stage I, FVC showed the most pronounced associations with new-onset CM and T2D among the four mutually exclusive end points. Compared with the lowest quartile (quartile 1), the adjusted ORs of quartile 4 of FVC were 0.525 (95% CI, 0.468-0.589) for CM, 0.534 (95% CI, 0.498-0.572) for T2D alone, 0.817 (95% CI, 0.751-0.888) for stroke alone, and 0.800 (95% CI, 0.764-0.837) for CHD alone. In stage II, FVC also was associated with the risk of CM in patients with T2D (HR of quartile 4, 0.727; 95% CI, 0.649-0.814), patients with CHD (HR, 0.635; 95% CI, 0.555-0.727), and patients who experienced stroke (HR, 0.783, 95% CI, 0.642-0.955). Similar results were observed for FEV1 in both stages.

Interpretation: This study revealed the different risk associations of pulmonary function with individual cardiometabolic diseases and CM. Tailor-made screening and monitoring through pulmonary function may be applicable for the precise prevention and control of these conditions.

Keywords: cardiometabolic multimorbidity; coronary heart disease; pulmonary function; stroke; type 2 diabetes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiovascular Diseases* / epidemiology
  • Coronary Disease*
  • Diabetes Mellitus, Type 2* / epidemiology
  • Humans
  • Multimorbidity
  • Risk Factors
  • Stroke* / epidemiology