Lung Function and Risk of Type 2 Diabetes and Fatal and Nonfatal Major Coronary Heart Disease Events: Possible Associations With Inflammation
- S. Goya Wannamethee, PHD1,
- A. Gerald Shaper, FRCP1,
- Ann Rumley, PHD2,
- Naveed Sattar, FRCPATH2,
- Peter H. Whincup, FRCP, PHD3,
- Mary C. Thomas, MSC1 and
- Gordon D. Lowe, DSC2
- 1Department of Primary Care and Population Health, University College Medical School, London, U.K.;
- 2British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Royal Infirmary, Glasgow, U.K.;
- 3Division of Community Health Sciences, St George's, University of London, London, U.K.
- Corresponding author: S. Goya Wannamethee, g.wannamethee{at}ucl.ac.uk.
Abstract
OBJECTIVE We prospectively examined the relationship between lung function and risk of type-2 diabetes and fatal and nonfatal coronary heart disease (CHD) events and investigated the hypothesis that inflammation may underlie these associations.
RESEARCH DESIGN AND METHODS A prospective study of 4,434 men aged 40–59 years with no history of cardiovascular disease (CHD or stroke) or diabetes drawn from general practices in 24 British towns and followed up for 20 years.
RESULTS There were 680 major CHD events (276 fatal, 404 nonfatal) and 256 incident type 2 diabetes during the 20 years follow-up. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) but not FEV1-to-FVC ratio were significantly and inversely associated with incident type 2 diabetes and fatal CHD events (not nonfatal events) after adjustment for age, potential confounders, and metabolic risk factors. The adjusted relative risk (RR) for type 2 diabetes (Quartile 1 vs. Quartile 4) were 1.59 (1.07–2.56) and 1.74 (1.16–2.61) for FVC and FEV1, respectively (P = 0.03 and P = 0.04 for trend). The corresponding RR for fatal CHD were 1.48 (1.00–2.21) and 1.81 (1.19–2.76) (P = 0.002 and P = 0.0003 for trend). Lung function was significantly and inversely associated with C-reactive protein and interleukin-6; the inverse associations with type 2 diabetes for FVC and FEV1 were attenuated after further adjustment for these factors (P = 0.14 and P = 0.11 for trend) but remained significant for fatal CHD (P = 0.03 and P = 0.01, respectively).
CONCLUSIONS Restrictive rather than obstructive impairment of lung function is associated with incident type 2 diabetes (and fatal CHD) with both associations partially explained by traditional and metabolic risk factors and inflammation.
Footnotes
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- Received February 18, 2010.
- Accepted May 27, 2010.
- © 2010 by the American Diabetes Association.
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