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Lung function impairment tied to increased risk of heart failure

European Heart Journal
Reuters Health - 11/05/2022 - Obstructive or restrictive pulmonary disease was independently associated with an increased risk of heart failure (HF) in a cohort study, with a particularly high risk seen in patients with HF with preserved ejection fraction (HFpEF), researchers say.

"Our study was born out of our recognition that many patients with chronic lung diseases have comorbid HF," Dr. Christina Eckhardt and Dr. Elizabeth Oelsner, both of Columbia University Medical Center in New York City, told Reuters Health by email.

"While many HF risk factors such as hypertension, diabetes and smoking are well-established, lung function impairment appeared to represent an important yet underappreciated cardiac risk factor," they said. "Our research ultimately suggests that recognition of lung function impairment could be critically important for the prevention, early diagnosis, and prognostication of chronic HF."

"We were surprised to see that lung function impairment was associated with incident HF to a similar extent as major known HF risk factors," they added. "Clinicians should consider evaluating patients with lung function impairment for comorbid heart HF, and may advise HF prevention strategies, including regular physical activity, dietary interventions, tobacco cessation, and moderation of alcohol intake."

As reported in the European Heart Journal, Drs. Eckhardt, Oelsner and colleagues pooled data from eight U.S. population-based cohorts that enrolled participants from 1987 to 2004 who had lung function impairment, either obstructive (forced expiratory volume in 1 s/forced vital capacity,0.70) or restrictive (FEV1/FVC, 0.70 or more; FVC, 80%).

Restrictive physiology was characterized by reduced lung volumes; obstructive physiology was characterized by airflow limitation and hyperinflation.

Incident HF was defined as hospitalization or death caused by HF.

In a subset, HF events were classified as HF with reduced ejection fraction (HFrEF; EF, 50%) or HFpEF; EF 50% or more.

Among 31,677 patients (mean age, about 58; about 55%, women), 3,344 incident HF events occurred over a median follow-up of 21 years.

Among 2,066 classifiable events, 1,030 were HFrEF and 1,036, HFpEF.

Both obstructive and restrictive physiology were associated with incident HF (adjusted hazard ratios, 1.17 and 1.43, respectively); however, obstructive and restrictive ventilatory defects were associated with HFpEF, but not HFrEF.

As Drs. Eckhardt and Oelsner noted, the magnitude of the association between restrictive physiology and HFpEF was similar to associations with hypertension, diabetes, and smoking.

Dr. Bradley Maron of Brigham and Women's Hospital in Boston and Dr. Marc Humbert of Universite Paris-Saclay, INSERM in France, coauthors of a related editorial, commented in an email to Reuters Health, "The presence of HFpEF with lung disease is a high-risk finding; however, the current approach to diagnosing and evaluating HFpEF patients does not include a standard assessment of lung function. This identifies a potential diagnosis and treatment gap in HFpEF, since many patients will have a treatable form of lung disease."

"We propose that greater attention is needed to consider lung disease in HFpEF," they said. "Specifically, formal collaboration between cardiologists and pulmonologists in the diagnosis and approach to HFpEF patients is likely to be an important and helpful improvement in the approach to this large and vulnerable patient population."

SOURCE: https://bit.ly/3ssY5YM European Heart Journal, online April 25, 2022.

By Marilynn Larkin

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