Advertisement

Prospective study of lung function and abdominal aortic aneurysm risk: The Atherosclerosis Risk in Communities study

      Highlights

      • No prospective study has examined the association between lung function and abdominal aortic aneurysm (AAA).
      • We examined this association using a prospective population-based study in the US.
      • Chronic obstructive pulmonary disease (COPD) and restrictive diseases patterns were associated with increased AAA risk.
      • This study suggested COPD and restrictive lung diseases may increase AAA risk.

      Abstract

      Background and aims

      No prospective study has investigated whether individuals with respiratory impairments, including chronic obstructive pulmonary disease (COPD) and restrictive lung disease (RLD), are at increased risk of abdominal aortic aneurysm (AAA). We aimed to prospectively investigate whether those respiratory impairments are associated with increased AAA risk.

      Methods

      In 1987–1989, the Atherosclerosis Risk in Communities (ARIC) study followed 14,269 participants aged 45–64 years, without a history of AAA surgery, through 2011. Participants were classified into four groups, “COPD” [forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <lower limit of normal (LLN)], “RLD” (FEV1/FVC ≥ LLN and FVC < LLN), “respiratory symptoms with normal spirometry” (without RLD or COPD), and “normal” (without respiratory symptoms, RLD or COPD, reference group).

      Results

      During the 284,969 person-years of follow-up, 534 incident AAA events were documented. In an age, sex, and race-adjusted proportional hazards model, individuals with respiratory impairments had a significantly higher risk of AAA than the normal reference group. After adjustment for AAA risk factors, including smoking status and pack-years of smoking, AAA risk was no longer significant in the respiratory symptoms with normal spirometry group [HR (95% CI), 1.25 (0.98–1.60)], but was still increased in the other two groups [RLD: 1.45 (1.04–2.02) and COPD: 1.66 (1.34–2.05)]. Moreover, continuous measures of FEV1/FVC, FEV1 and FVC were associated inversely with risk of AAA.

      Conclusions

      In the prospective population-based cohort study, obstructive and restrictive spirometric patterns were associated with increased risk of AAA independent of smoking, suggesting that COPD and RLD may increase the risk of AAA.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • U.S. Preventive Services Task Force
        Screening for abdominal aortic aneurysm: recommendation statement.
        Ann. Intern Med. 2005; 142: 198-202
        • Ashton H.A.
        • Buxton M.J.
        • Day N.E.
        • Kim L.G.
        • Marteau T.M.
        • et al.
        The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial.
        Lancet. 2002; 360: 1531-1539
        • Limet R.
        • Sakalihassan N.
        • Albert A.
        Determination of the expansion rate and incidence of rupture of abdominal aortic aneurysms.
        J. Vasc. Surg. 1991; 14: 540-548
        • Bengtsson H.
        • Bergqvist D.
        • Ekberg O.
        • Janzon L.
        A population based screening of abdominal aortic aneurysms (AAA).
        Eur. J. Vasc. Surg. 1991; 5: 53-57
        • Smith F.C.
        • Grimshaw G.M.
        • Paterson I.S.
        • Shearman C.P.
        • Hamer J.D.
        Ultrasonographic screening for abdominal aortic aneurysm in an urban community.
        Br. J. Surg. 1993; 80: 1406-1409
        • Cronenwett J.L.
        • Murphy T.F.
        • Zelenock G.B.
        • Whitehouse Jr., W.M.
        • Lindenauer S.M.
        • et al.
        Actuarial analysis of variables associated with rupture of small abdominal aortic aneurysms.
        Surgery. 1985; 98: 472-483
        • Sakamaki F.
        • Oya H.
        • Nagaya N.
        • Kyotani S.
        • Satoh T.
        • et al.
        Higher prevalence of obstructive airway disease in patients with thoracic or abdominal aortic aneurysm.
        J. Vasc. Surg. 2002; 36: 35-40
        • Meijer C.A.
        • Kokje V.B.
        • van Tongeren R.B.
        • Hamming J.F.
        • van Bockel J.H.
        • et al.
        An association between chronic obstructive pulmonary disease and abdominal aortic aneurysm beyond smoking: results from a case-control study.
        Eur. J. Vasc. Endovasc. Surg. 2012; 44: 153-157https://doi.org/10.1016/j.ejvs.2012.05.016
        • Fowkes F.G.
        • Anandan C.L.
        • Lee A.J.
        • Smith F.B.
        • Tzoulaki I.
        • et al.
        Reduced lung function in patients with abdominal aortic aneurysm is associated with activation of inflammation and hemostasis, not smoking or cardiovascular disease.
        J. Vasc. Surg. 2006; 43: 474-480
        • Folsom A.R.
        • Yao L.
        • Alonso A.
        • Lutsey P.L.
        • Missov E.
        • et al.
        Circulating biomarkers and abdominal aortic aneurysm incidence: the atherosclerosis risk in communities (ARIC) study.
        Circulation. 2015; 132: 578-585https://doi.org/10.1161/CIRCULATIONAHA.115.016537
        • The Atherosclerosis Risk in Communities (ARIC)
        Study: Design and objectives. The ARIC Investigators.
        Am. J. Epidemiol. 1989; 129: 687-702
      1. Atherosclerosis Risk in Communities Study Manual 4: Pulmonary Function. Chapel Hill NNH, Lung, and Blood Institute of the National Institutes of Health, Collaborative Studies Coordinating Center, University of North Carolina, Chapel Hill, NC1987
        • Hankinson J.L.
        • Odencrantz J.R.
        • Fedan K.B.
        Spirometric reference values from a sample of the general U.S. population.
        Am. J. Respir. Crit. Care Med. 1 1999 Jan; 159: 179-187
        • Ferris B.G.
        Epidemiology standardization project (American thoracic society).
        Am. Rev. Respir. Dis. 1978; 118: 1-120
        • Kubota Y.
        • London S.J.
        • Cushman M.
        • Chamberlain A.M.
        • Rosamond W.D.
        • et al.
        Lung function, respiratory symptoms and venous thromboembolism risk: the Atherosclerosis Risk in Communities Study.
        J. Thromb. Haemost. 2016; 14: 2394-2401https://doi.org/10.1111/jth.13525
        • Kubota Y.
        • Evenson K.R.
        • MacLehose R.F.
        • Roetker N.S.
        • Joshu C.E.
        • et al.
        Physical activity and lifetime risk of cardiovascular disease and cancer.
        Med. Sci. Sports Exerc. 2017 Aug; 49: 1599-1605https://doi.org/10.1249/MSS.0000000000001274
        • Kubota Y.
        • Heiss G.
        • MacLehose R.F.
        • Roetker N.S.
        • Folsom A.R.
        Educational attainment and lifetime risk of cardiovascular disease: the atherosclerosis risk in communities study.
        JAMA Intern. Med. 2017 Aug 1; 177: 1165-1172https://doi.org/10.1001/jamainternmed.2017.1877
        • Tang W.
        • Yao L.
        • Roetker N.S.
        • Alonso A.
        • Lutsey P.L.
        • et al.
        Lifetime risk and risk factors for abdominal aortic aneurysm in a 24-year prospective study: the ARIC study (atherosclerosis risk in communities).
        Arterioscler. Thromb. Vasc. Biol. 2016; 36: 2468-2477
        • Kubota Y.
        • McAdams-DeMarco M.
        • Folsom A.R.
        Serum uric acid, gout, and venous thromboembolism: the atherosclerosis risk in communities study.
        Thromb. Res. 2016; 144: 144-148https://doi.org/10.1016/j.thromres.2016.06.020
        • Eagleton M.J.
        Inflammation in abdominal aortic aneurysms: cellular infiltrate and cytokine profiles.
        Vascular. 2012; 20: 278-283https://doi.org/10.1258/vasc.2011.201207
        • Szekanecz Z.
        • Shah M.R.
        • Pearce W.H.
        • Koch A.E.
        Human atherosclerotic abdominal aortic aneurysms produce interleukin (IL)-6 and interferon-gamma but not IL-2 and IL-4: the possible role for IL-6 and interferon-gamma in vascular inflammation.
        Agents Actions. 1994; 42: 159-162
        • Pearce W.H.
        • Sweis I.
        • Yao J.S.
        • McCarthy W.J.
        • Koch A.E.
        Interleukin-1 beta and tumor necrosis factor-alpha release in normal and diseased human infrarenal aortas.
        J. Vasc. Surg. 1992; 16: 784-789
        • Newman K.M.
        • Jean-Claude J.
        • Li H.
        • Ramey W.G.
        • Tilson M.D.
        Cytokines that activate proteolysis are increased in abdominal aortic aneurysms.
        Circulation. 1994; 90: II224-II227
        • Malik N.
        • Greenfield B.W.
        • Wahl A.F.
        • Kiener P.A.
        Activation of human monocytes through CD40 induces matrix metalloproteinases.
        J. Immunol. 1996; 156: 3952-3960
        • Lacraz S.
        • Isler P.
        • Vey E.
        • Welgus H.G.
        • Dayer J.M.
        Direct contact between T lymphocytes and monocytes is a major pathway for induction of metalloproteinase expression.
        J. Biol. Chem. 1994; 269: 22027-22033
        • Wouters E.F.
        • Groenewegen K.H.
        • Dentener M.A.
        • Vernooy J.H.
        Systemic inflammation in chronic obstructive pulmonary disease: the role of exacerbations.
        Proc. Am. Thorac. Soc. 2007; 4: 626-634
        • Tzouvelekis A.
        • Kouliatsis G.
        • Anevlavis S.
        • Bouros D.
        Serum biomarkers in interstitial lung diseases.
        Respir. Res. 2005; 6: 78
        • Gläser S.
        • Ittermann T.
        • Koch B.
        • Völzke H.
        • Wallaschofski H.
        • et al.
        Airflow limitation, lung volumes and systemic inflammation in a general population.
        Eur. Respir. J. 2012; 39: 29-37https://doi.org/10.1183/09031936.00009811
        • Fogarty A.W.
        • Lewis S.A.
        • McKeever T.M.
        • Lowe G.D.
        • Clark L.
        • et al.
        The association between blood coagulation activity and lung function: a population-based study.
        PLoS One. 2010; 5 (e15014)https://doi.org/10.1371/journal.pone.0015014
        • Crooks M.G.
        • Hart S.P.
        Coagulation and anticoagulation in idiopathic pulmonary fibrosis.
        Eur. Respir. Rev. 2015; 24: 392-399https://doi.org/10.1183/16000617.00008414
        • Golledge J.
        • Tsao P.S.
        • Dalman R.L.
        • Norman P.E.
        Circulating markers of abdominal aortic aneurysm presence and progression.
        Circulation. 2008; 118: 2382-2392https://doi.org/10.1161/CIRCULATIONAHA.108.802074
        • Smith B.M.
        • Kawut S.M.
        • Bluemke D.A.
        • Basner R.C.
        • Gomes A.S.
        • et al.
        Pulmonary hyperinflation and left ventricular mass: the multi-ethnic study of atherosclerosis COPD study.
        Circulation. 2013; 127 (1511e1–6): 1503-1511https://doi.org/10.1161/CIRCULATIONAHA.113.001653
        • Iarussi D.
        • Caruso A.
        • Galderisi M.
        • Covino F.E.
        • Dialetto G.
        • et al.
        Association of left ventricular hypertrophy and aortic dilation in patients with acute thoracic aortic dissection.
        Angiology. 2001; 52: 447-455
        • Cuspidi C.
        • Meani S.
        • Negri F.
        • Sala C.
        • Mancia G.
        Left ventricular hypertrophy and abdominal aorta size in essential hypertension.
        J. Hypertens. 2011; 29: 1213-1219https://doi.org/10.1097/HJH.0b013e328345954f
        • Woodruff P.G.
        • Barr R.G.
        • Bleecker E.
        • Christenson S.A.
        • Couper D.
        • et al.
        Clinical significance of symptoms in smokers with preserved pulmonary function.
        N. Engl. J. Med. 2016; 374: 1811-1821https://doi.org/10.1056/NEJMoa1505971
        • Divo M.
        • Cote C.
        • de Torres J.P.
        • Casanova C.
        • Marin J.M.
        • et al.
        Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease.
        Am. J. Respir. Crit. Care Med. 2012; 186: 155-161https://doi.org/10.1164/rccm.201201–0034OC
        • Cazzola M.
        • Bettoncelli G.
        • Sessa E.
        • Cricelli C.
        • Biscione G.
        Prevalence of comorbidities in patients with chronic obstructive pulmonary disease.
        Respiration. 2010; 80: 112-119https://doi.org/10.1159/000281880
        • Thomsen M.
        • Ingebrigtsen T.S.
        • Marott J.L.
        • Dahl M.
        • Lange P.
        • et al.
        Inflammatory biomarkers and exacerbations in chronic obstructive pulmonary disease.
        JAMA. 2013; 309: 2353-2361https://doi.org/10.1001/jama.2013.5732
        • Mannino D.M.
        • Davis K.J.
        Lung function decline and outcome in an elderly population.
        Thorax. 2006; 61: 472-477