Risk factors

The latest tool for cardiac risk screening: spirometry


A modest reduction in lung function is associated with significant increased risk of sudden cardiac death (SCD) and non-fatal coronary events, according to European researchers who suggest spirometry for cardiac risk screening.

A Swedish study presented at the European Respiratory Society (ERS) 2021 Congress, assessed baseline spirometry in 28,584 middle-aged people with no previous history of acute coronary events.

The cohort, from the Malmö Preventive Project, was followed prospectively for incidence of SCD or non-fatal coronary events for a mean of 30 years.

Dr Suneela Zaigham, a researcher in cardiovascular epidemiology at Lund University, told the Congress that SCD was an unexpected and devastating event.

“Although sudden cardiac deaths are common, we don’t know enough about who is at risk in the general population. There are links between lung and heart health, so we wanted to investigate whether measurable differences in lung function could offer clues about the risk of sudden cardiac death.”

”We found that a 1-standard deviation (SD) reduction in FEV1 was more strongly associated with SCD than non-fatal CE, even after full adjustments for potential confounders,” she said.

The Hazard ratio (HR) for SCD was 1.23 (1.15-1.31) and for non-fatal coronary events was 1.08 (1.04-1.13), (p = 0.002).

Similar associations were found for a 1-SD reduction in FVC but not FEV1 /FVC.

The results remained significant even in life-long never-smokers (HR for SCD: 1.34 (1.15- 1.55), HR for non-fatal CE: 1.11 (1.02-1.21), p=0.038).

Dr Zaigham said the results supported the use of spirometry for global assessment of cardiovascular risk.

“We believe this is the first study to directly compare the risk of sudden cardiac death and non-fatal coronary events and their links with lung function in the general population.”

“Our findings suggest that testing people’s lungs when they are middle-aged and healthy could help spot those who have a higher risk of sudden cardiac death. This could enable people to take steps to potentially reduce the risk of this devastating event.”

“We propose that measurement with spirometry in early life could aid in the risk stratification of future SCD.”

Commenting on the study, Professor Marc Humbert from the Université Paris-Saclay in France, said lung function could easily be used as part of a screening tool.

“This study suggests a link between lung health and sudden cardiac death. It shows a higher risk of fatal than non-fatal coronary events even in people whose lung function is moderately lower but may still be within a normal range,” he said.

Professor Humbert, incoming President of the European Respiratory Society, added that more research was required to understand the links between lung function and sudden cardiac death and to confirm whether lung function tests could help prevent deaths in the future.

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