Background Many of those who suffer from a first acute coronary event (CE) die suddenly during the day of the event, most of them die outside hospital. Poor lung function is a strong predictor of future cardiac events; however, it is unknown whether the pattern of lung function impairment differs for the prediction of sudden cardiac death (SCD) versus non-fatal CEs. We examined measures of lung function in relation to future SCD and non-fatal CE in a population-based study. Methods Baseline spirometry was assessed in 28 584 middle-aged subjects, without previous history of CE, from the Malmö Preventive Project. The cohort was followed prospectively for incidence of SCD (death on the day of a first CE, inside or outside hospital) or non-fatal CE (survived the first day). A modified version of the Lunn McNeil’s competing risk method for Cox regression was used to run models for both SCD and non-fatal CE simultaneously. Results A 1-SD reduction in forced expiratory volume in 1 s (FEV1) was more strongly associated with SCD than non-fatal CE even after full adjustment (FEV1: HR for SCD: 1.23 (1.15 to 1.31), HR for non-fatal CE 1.08 (1.04 to 1.13), p value for equal associations=0.002). Similar associations were found for forced vital capacity (FVC) but not FEV1/FVC. The results remained significant even in life-long never smokers (FEV1: HR for SCD: 1.34 (1.15 to 1.55), HR for non-fatal CE: 1.11 (1.02 to 1.21), p value for equal associations=0.038). Similar associations were seen when % predicted values of lung function measures were used. Conclusions Low FEV1 is associated with both SCD and non-fatal CE, but consistently more strongly associated with future SCD. Measurement with spirometry in early life could aid in the risk stratification of future SCD. The results support the use of spirometry for a global assessment of cardiovascular risk. Data are available upon reasonable request.

中文翻译：

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一般人群中肺功能低下、心源性猝死和非致命性冠状动脉事件

背景 许多首次急性冠脉事件 (CE) 患者在事件发生当天突然死亡，其中大多数在医院外死亡。肺功能差是未来心脏事件的强预测指标；然而，对于预测心源性猝死 (SCD) 与非致命性 CE 的肺功能损害模式是否不同，尚不清楚。我们在一项基于人群的研究中检查了与未来 SCD 和非致命性 CE 相关的肺功能指标。方法 对来自 Malmö 预防项目的 28 584 名没有 CE 病史的中年受试者进行基线肺量测定。对队列进行前瞻性随访，了解 SCD（第一次 CE 当天死亡，医院内外）或非致命性 CE（第一天存活）的发生率。Lunn McNeil 的 Cox 回归竞争风险方法的修改版本用于同时运行 SCD 和非致命 CE 模型。结果 即使在完全调整后，1 秒内用力呼气量 (FEV1) 减少 1-SD 与 SCD 的相关性也比非致命性 CE 更强（FEV1：SCD 的 HR：1.23（1.15 至 1.31），非致命性的 HR CE 1.08（1.04 到 1.13），相等关联的 p 值 = 0.002）。用力肺活量 (FVC) 但 FEV1/FVC 没有发现类似的关联。即使在终生从不吸烟者中，结果仍然显着（FEV1：SCD 的 HR：1.34（1.15 至 1.55），非致命 CE 的 HR：1.11（1.02 至 1.21），相等关联的 p 值 = 0.038）。当使用肺功能测量的百分比预测值时，可以看到类似的关联。结论 低 FEV1 与 SCD 和非致命性 CE 相关，但始终与未来的 SCD 更密切相关。在生命早期使用肺活量测定法进行测量有助于未来 SCD 的风险分层。结果支持使用肺活量测定法对心血管风险进行全球评估。可应合理要求提供数据。