Lung Function Impairment and Risks of Incident Cardiovascular Diseases and Mortality Among People With Type 2 Diabetes: A Prospective Cohort Study
Individuals with type 2 diabetes (T2D) frequently exhibit impaired lung function, potentially accelerating the onset of cardiovascular diseases (CVD), although prospective studies remain limited. We aimed to explore the relationship between lung function impairment and risk of CVD and mortality within this high-risk population.
RESEARCH DESIGN AND METHODS
This prospective study included 16,242 participants with T2D and free of CVD from the UK Biobank. Obstructive physiology (OP), restrictive physiology (RP), and preserved ratio impaired spirometry (PRISm) were defined using spirometry including forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). The Fine and Gray sub-distribution hazards models and Cox proportional hazards models were used to estimate risks of CVD and all-cause mortality, respectively.
RESULTS
During a median follow-up of 13.9 years, 2,825 CVD and 2,811 deaths were documented. Lower FEV1, FVC, FEV1/FVC ratio, FEV1 % predicted, and FVC % predicted were related to higher risks of CVD and all-cause mortality. Compared with preserved lung function, the adjusted sub-distribution HRs (95% CIs) for CVD were 1.19 (95% CI: 1.05-1.35) for OP and 1.47 (95% CI: 1.33-1.65) for RP. Compared with the control group, the sub-distribution HRs (95% CIs) for CVD were 1.20 (95% CI: 1.06-1.36) for OP and 1.43 (95% CI: 1.29-1.59) for PRISm. These associations were consistent across subgroups and sensitivity analyses. Adding the lung function measurements significantly enhanced the performance of CVD prediction beyond the SCORE2-Diabetes model.
CONCLUSIONS
