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Electronic letters published:
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Pulmonary function - an outsider in cardiovascular risk prediction
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Holger J Schünemann, MD, PhD Italian National Cancer Institute Regina Elena, Rome, Italy
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hjs{at}buffalo.edu Holger J Schünemann
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To the editor: Congratulations on publishing the important paper and the accompanying editorial examining the predictive ability of C-Reactive Protein (CRP) for cardiovascular risk in women (1, 2). These are masterpieces in terms of statistical analysis and contributions to our understanding of cardiovascular risk prediction. However, from a predictive and perhaps biological standpoint – the latter not being resolved – a very important variable has been omitted: Pulmonary function, commonly measured as forced expiratory volume in one second (FEV1) is one of the most powerful predictors of cardiovascular risk with a relative risk of approximately 2.0 when the highest to the lowest quintile of FEV1 are compared. This has been shown consistently and in numerous studies over the past 30 years (3-6). FEV1 and other pulmonary function measures appear to be independent risk factors and of the same or greater magnitude compared to other factors, including tobacco smoke exposure, age, gender and cholesterol levels. Moreover, its association with cardiovascular risk may be linked to CRP (7, 8). While the underlying biology, if any, has not been understood and could help explain the link between CRP and cardiovascular disease, the omission of this variable represents a limitation of this analysis. It is not clear why the cardiovascular research community has not embraced this simple measurement in epidemiological studies despite its consistent association with mortality, in particular related to cardiovascular disease. Future studies should include pulmonary function measurements because of its demonstrated strength and consistency as a risk factor. At a minimum readers and users of the model should be aware of this limitation. References 1. Cook NR, Buring JE, Ridker PM. The Effect of Including C-Reactive Protein in Cardiovascular Risk Prediction Models for Women. Ann Intern Med 2006;145(1):21-29. 2. Davey Smith G, Timpson N, Lawlor DA. C-Reactive Protein and Cardiovascular Disease Risk: Still an Unknown Quantity? Ann Intern Med 2006;145(1):70-72. 3. Schünemann HJ, Dorn J, Grant BJ, Winkelstein W, Jr., Trevisan M. Pulmonary function is a long-term predictor of mortality in the general population: 29-year follow-up of the Buffalo Health Study. Chest 2000;118(3):656-64. 4. Hole DJ, Watt GC, Davey-Smith G, Hart CL, Gillis CR, Hawthorne VM. Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study. Bmj 1996;313(7059):711-5; discussion 715-6. 5. Friedman GD, Klatsky AL, Siegelaub AB. Lung function and risk of myocardial infarction and sudden cardiac death. N Engl J Med 1976;294(20):1071-5. 6. Sin DD, Wu L, Man SF. The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature. Chest 2005;127(6):1952-9. 7. Gan WQ, Man SF, Sin DD. The interactions between cigarette smoking and reduced lung function on systemic inflammation. Chest 2005;127(2):558-64. 8. Gan WQ, Man SF, Senthilselvan A, Sin DD. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax 2004;59(7):574-80. Conflict of Interest:None declared |
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