Reduced pulmonary function, low-grade inflammation and increased risk of total and cardiovascular mortality in a general adult population: Prospective results from the Moli-sani study

• Published in: Respiratory medicine Vol. 184; p. 106441
• Main Authors: Costanzo, Simona, Magnacca, Sara, Bonaccio, Marialaura, Di Castelnuovo, Augusto, Piraino, Alessio, Cerletti, Chiara, de Gaetano, Giovanni, Donati, Maria Benedetta, Iacoviello, Licia
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2021; Elsevier Limited
• Subjects: Adult; Age Factors; Aged; Asthma; Biomarkers; Blood Cell Count; C-Reactive Protein; Cardiovascular diseases; Cardiovascular Diseases - mortality; Cardiovascular Diseases - physiopathology; Disease; Female; FEV1 quotient (FEV1Q); Follow-Up Studies; Forced expiratory flow at 25–75% of FVC (FEF25-75); Forced Expiratory Volume; Forced expiratory volume in the first second (FEV1); Forced vital capacity (FVC); General adult population; Humans; Inflammation; Laboratories; Lung - physiopathology; Lung diseases; Male; Maximal Midexpiratory Flow Rate; Middle Aged; Mortality; Population; Prospective Studies; Respiratory function; Risk; Risk Factors; Spirometry; Standard deviation; Statistical analysis; Variance analysis; Vital Capacity; Italy; Forced expiratory volume in the first second (FEV1); FEV1 quotient (FEV1Q); Forced expiratory flow at 25–75% of FVC (FEF25-75); Forced vital capacity (FVC); Mortality; General adult population
• ISSN: 0954-6111; 1532-3064; 1532-3064
• DOI: 10.1016/j.rmed.2021.106441

to investigate the relation of pulmonary function impairment with mortality and the possible mediation by low-grade inflammation in a general adult population. A prospective investigation was conducted on 14,503 individuals from the Moli-sani study (apparently free from lung disease and acute inflammatory status at baseline; 2005–2010). The 2012 Global Lung Function Initiative percent predicted (% pred) value of forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), forced expiratory flow at 25–75% of FVC (FEF25-75) and FEV1 quotient (FEV1Q) index were used. C-reactive protein and blood cell counts were measured and a score of subclinical inflammation (INFLA-score) was calculated. Over a median follow-up of 8.6y, 503 deaths (28.9% cardiovascular) were ascertained. Total mortality increased by 19% for each decrease in 1 standard deviation of FEV1% pred or FVC% pred (Hazard Ratio:1.19; 95% CI:1.11–1.28 and 1.19; 1.10–1.28, respectively). Comparable findings for FEV1Q (1.30; 1.15–1.47) were observed. A statistically significant increased risk in cardiovascular mortality of 23%, 32% and 49% was observed for 1 standard deviation decrease of FEV1% pred, FVC% pred and FEV1Q, respectively. INFLA-score mediated the association of FEV1% pred and FEV1Q with cardiovascular mortality by 22.3% and 20.1%, respectively. Subjects with FEV1, FVC lower than normal limit showed increased risk both in total and cardiovascular mortality. Abnormal FEF25-75 values were associated with 33% (1.33; 1.02–1.74) total mortality risk. Obstructive lung function impairment was associated with decreased survival. Low-grade inflammation mainly mediated the association of FEV1 with cardiovascular mortality. •Lung function parameters were inversely associated with low-grade inflammation.•Lung function decline was associated with a high total and cardiovascular mortality.•Low-grade inflammation mediates the link between FEV1 and cardiovascular mortality.