Airflow obstruction, lung function, and risk of incident heart failure: The Atherosclerosis Risk in Communities (ARIC) study

Sunil K. Agarwal, Gerardo Heiss, R. Graham Barr, Patricia P. Chang, Laura R. Loehr, Lloyd E. Chambless, Eyal Shahar, Dalane W. Kitzman, Wayne D. Rosamond

Research output: Contribution to journalArticlepeer-review

93 Scopus citations


Aims: We examined the relationship between forced expiratory volume in 1 s (FEV1), airflow obstruction, and incident heart failure (HF) in black and white, middle-aged men and women in four US communities. Methods and results: Lung volumes by standardized spirometry and information on covariates were collected on 15 792 Atherosclerosis Risk in Communities (ARIC) cohort participants in 198789. Incident HF was ascertained from hospital records and death certificates up to 2005 in 13 660 eligible participants. Over an average follow-up of 14.9 years, 1369 (10) participants developed new-onset HF. The age-and height-adjusted hazard ratios (HRs) for HF increased monotonically over descending quartiles of FEV1 for both genders, race groups, and smoking status. After multivariable adjustment for traditional cardiovascular risk factors and height, the HRs [95 confidence intervals (CIs)] of HF comparing the lowest with the highest quartile of FEV1 were 3.91 (2.406.35) for white women, 3.03 (2.124.33) for white men, 2.11 (1.333.34) for black women, and 2.23 (1.373.59) for black men. The association weakened but remained statistically significant after additional adjustment for systemic markers of inflammation. The multivariable adjusted incidence of HF was higher in those with FEV1/forced vital capacity <70 vs. <70: HR 1.44 (95 CI 1.201.74) among men and 1.40 (1.131.72) among women. A consistent and positive association with HF was seen for self-reported diagnosis of emphysema and chronic obstructive pulmonary disease, but not for asthma. Conclusions: In this large population-based cohort with long-term follow-up, low FEV1 and an obstructive respiratory disease were strongly and independently associated with the risk of incident HF. Published on behalf of the European Society of Cardiology. All rights reserved.

Original languageEnglish (US)
Pages (from-to)414-422
Number of pages9
JournalEuropean Journal of Heart Failure
Issue number4
StatePublished - Apr 2012


  • COPD
  • Cohort study
  • Heart failure
  • Lung function
  • Risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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