The Lancet Regional Health. Western Pacific (Jan 2025)

Spirometric pattern and cardiovascular risk: a prospective study of 0.3 million Chinese never-smokersResearch in context

  • Yinqi Ding,
  • Jingcen Hu,
  • Canqing Yu,
  • Dianjianyi Sun,
  • Pei Pei,
  • Ling Yang,
  • Yiping Chen,
  • Huaidong Du,
  • Libo Zhang,
  • Dan Schmidt,
  • Maxim Barnard,
  • Junshi Chen,
  • Zhengming Chen,
  • Liming Li,
  • Jun Lv,
  • Junshi Chen,
  • Zhengming Chen,
  • Robert Clarke,
  • Rory Collins,
  • Liming Li,
  • Jun Lv,
  • Richard Peto,
  • Robin Walters,
  • Daniel Avery,
  • Maxim Barnard,
  • Derrick Bennett,
  • Ruth Boxall,
  • Ka Hung Chan,
  • Yiping Chen,
  • Zhengming Chen,
  • Charlotte Clarke,
  • Johnathan Clarke,
  • Robert Clarke,
  • Huaidong Du,
  • Ahmed Edris Mohamed,
  • Hannah Fry,
  • Simon Gilbert,
  • Pek Kei Im,
  • Andri Iona,
  • Maria Kakkoura,
  • Christiana Kartsonaki,
  • Kshitij Kolhe,
  • Hubert Lam,
  • Kuang Lin,
  • James Liu,
  • Mohsen Mazidi,
  • Iona Millwood,
  • Sam Morris,
  • Qunhua Nie,
  • Alfred Pozarickij,
  • Maryam Rahmati,
  • Paul Ryder,
  • Dan Schmidt,
  • Becky Stevens,
  • Iain Turnbull,
  • Robin Walters,
  • Baihan Wang,
  • Lin Wang,
  • Neil Wright,
  • Ling Yang,
  • Xiaoming Yang,
  • Pang Yao,
  • Xiao Han,
  • Can Hou,
  • Qingmei Xia,
  • Chao Liu,
  • Jun Lv,
  • Pei Pei,
  • Dianjianyi Sun,
  • Canqing Yu,
  • Lang Pan,
  • Zengchang Pang,
  • Ruqin Gao,
  • Shanpeng Li,
  • Haiping Duan,
  • Shaojie Wang,
  • Yongmei Liu,
  • Ranran Du,
  • Yajing Zang,
  • Liang Cheng,
  • Xiaocao Tian,
  • Hua Zhang,
  • Yaoming Zhai,
  • Feng Ning,
  • Xiaohui Sun,
  • Feifei Li,
  • Silu Lv,
  • Junzheng Wang,
  • Wei Hou,
  • Wei Sun,
  • Shichun Yan,
  • Xiaoming Cui,
  • Chi Wang,
  • Zhenyuan Wu,
  • Yanjie Li,
  • Quan Kang,
  • Huiming Luo,
  • Tingting Ou,
  • Xiangyang Zheng,
  • Zhendong Guo,
  • Shukuan Wu,
  • Yilei Li,
  • Huimei Li,
  • Ming Wu,
  • Yonglin Zhou,
  • Jinyi Zhou,
  • Ran Tao,
  • Jie Yang,
  • Jian Su,
  • Fang Liu,
  • Jun Zhang,
  • Yihe Hu,
  • Yan Lu,
  • Liangcai Ma,
  • Aiyu Tang,
  • Shuo Zhang,
  • Jianrong Jin,
  • Jingchao Liu,
  • Mei Lin,
  • Zhenzhen Lu,
  • Lifang Zhou,
  • Changping Xie,
  • Jian Lan,
  • Tingping Zhu,
  • Yun Liu,
  • Liuping Wei,
  • Liyuan Zhou,
  • Ningyu Chen,
  • Yulu Qin,
  • Sisi Wang,
  • Xianping Wu,
  • Ningmei Zhang,
  • Xiaofang Chen,
  • Xiaoyu Chang,
  • Mingqiang Yuan,
  • Xia Wu,
  • Xiaofang Chen,
  • Wei Jiang,
  • Jiaqiu Liu,
  • Qiang Sun,
  • Faqing Chen,
  • Xiaolan Ren,
  • Caixia Dong,
  • Hui Zhang,
  • Enke Mao,
  • Xiaoping Wang,
  • Tao Wang,
  • Xi Zhang,
  • Kai Kang,
  • Shixian Feng,
  • Huizi Tian,
  • Lei Fan,
  • XiaoLin Li,
  • Huarong Sun,
  • Pan He,
  • Xukui Zhang,
  • Min Yu,
  • Ruying Hu,
  • Hao Wang,
  • Xiaoyi Zhang,
  • Yuan Cao,
  • Kaixu Xie,
  • Lingli Chen,
  • Dun Shen,
  • Xiaojun Li,
  • Donghui Jin,
  • Li Yin,
  • Huilin Liu,
  • Zhongxi Fu,
  • Xin Xu,
  • Hao Zhang,
  • Jianwei Chen,
  • Yuan Peng,
  • Libo Zhang,
  • Chan Qu,
  • Shuya Li,
  • Haiqiang Qin,
  • Yongjun Wang,
  • Qiling Chen,
  • Jihua Wang,
  • Xiaojia Sun,
  • Lei Wang,
  • Xun Wang,
  • Liming Zhang,
  • Shanshan Zhou,
  • Hongyuan Chen,
  • Li Chen,
  • Haiyan Gou,
  • Weizhi Wang,
  • Yanmei Zhu,
  • Yulan Zhu,
  • Ning Zhang,
  • Xin Cheng,
  • Qiang Dong,
  • Yi Dong,
  • Kun Fang,
  • Yiting Mao,
  • Yu An,
  • Peiling Chen,
  • Yinghua Chen,
  • Zhihong Liu,
  • Lihua Zhang,
  • Xiaohong Chen,
  • Naixin Jv,
  • Xiaojiu Li,
  • Liyang Liu,
  • Yun Lu,
  • Xiaona Xing,
  • Shihao You,
  • Xiaoli Cheng,
  • Chaojun Gua,
  • Jinping Jiang,
  • Jingyi Liu,
  • Shumei Ma,
  • Xuefeng Yang,
  • Xiaomo Du,
  • Jian Xu,
  • Xuecheng Yang,
  • Xiaodi Zhao,
  • Zilong Hao,
  • Ming Liu,
  • Deren Wang,
  • Xiaoting Li,
  • Lili Hui,
  • Zhanling Liao,
  • Feng Liu,
  • Chunning Feng,
  • Dejiang Ji,
  • Fengxia Qu,
  • Wenwen Yuan,
  • Xin Fu,
  • Jing Ding,
  • Peng Du,
  • Lirong Jin,
  • Yueshi Mao,
  • Xin Wang

Journal volume & issue
Vol. 54
p. 101274

Abstract

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Summary: Background: Existing studies have not provided robust evidence about the CVD risk of non-smoking patients with restrictive spirometric pattern (RSP) or airflow obstruction (AFO), and how the risk is modified by body shape. We aimed to bridge the gap. Methods: We used never-smokers' data from the China Kadoorie Biobank (CKB) and performed Cox models by sex (278,953 females and 50,845 males). Spirometry was used to assess the baseline spirometric pattern. CVD outcomes were captured through multiple sources. Findings: Females’ results were presented primarily, though males' results were similar. During a median 12-year (maximum 14.5 years) follow-up, both RSP and AFO patients had increased risks of acute myocardial infarction (AMI), other ischaemic heart disease (other IHD), heart failure, pulmonary heart disease, arrhythmia, and intracerebral haemorrhage (ICH). RSP was also associated with ischaemic stroke (IS). The HRs (95% CIs) for AFO in females ranged from 1.29 (1.15–1.45) for ICH to 8.84 (7.79–10.03) for pulmonary heart disease, while those for RSP ranged from 1.11 (1.08–1.15) for IS to 3.17 (2.80–3.59) for pulmonary heart disease. These risks increased with the severity of AFO and reduced FVC. RSP/AFO was more strongly associated with other IHD, heart failure, and pulmonary heart disease in underweight females than in normal and obese counterparts, respectively. Interpretation: With the confounding of smoking fully controlled, both RSP and AFO were associated with higher risks of various CVD outcomes, which further increased with the severity of AFO and reduced FVC. These associations were even stronger in underweight individuals. Funding: National Natural Science Foundation of China, National Key Research and Development Program of China, Ministry of Science and Technology of the People's Republic of China, Kadoorie Charitable Foundation, UK Wellcome Trust, UK Medical Research Council, Cancer Research UK, and British Heart Foundation.

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