Data_Sheet_1_Association of lung function with the risk of cardiovascular diseases and all-cause mortality in patients with diabetes: Results from NHANES III 1988-1994.docx

ObjectiveThe potential effects of pulmonary dysfunction on cardiovascular diseases (CVD) and all-cause mortality are receiving attention. The current study aimed to explore whether reduced lung function predicts CVD and all-cause mortality in people with diabetes.
MethodsA total of 1,723 adults with diabetes (mean age 60.2 years) were included in the National Health and Nutrition Examination Survey (NHANES III). Death outcomes were ascertained by linkage to the database records through 31 December 2015. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for coronary heart disease (CHD), CVD, and all-cause mortalities. We conducted stratified analyses based on age, body mass index (BMI), history of hypertension, and dyslipidemia.
ResultsDuring a mean follow-up of 14.62 years (25,184 person-year), a total of 1,221 deaths were documented, of which 327 were CHD, 406 were CVD, and 197 were cancer. After multi-factor adjustment, participants with lower FEV1 and FVC had a higher risk of CHD, CVD, and all-cause mortality. This association was also found in lower FVC and a higher risk of cancer mortality [HR: 3.85 (1.31–11.32); P for trend = 0.040], but the association of FEV1 was attenuated after adjustment for covariates [HR:2.23 (0.54–9.17); P for trend = 0.247]. In subgroup analysis, we found that the adverse associations of FEV1 and FVC with CVD mortality were observed in subgroups of age, BMI, and history of hypertension and dyslipidemia.
ConclusionDeclined lung function was associated with a higher risk of CVD and all-cause mortality in people with diabetes. Lung function tests, especially FEV1 and FVC, should be encouraged to provide prognostic and predictive information for the management of CVD and all-cause mortality in patients with diabetes.

研究目的：肺功能异常对心血管疾病（cardiovascular diseases, CVD）及全因死亡率的潜在影响正日益受到学界关注。本研究旨在探讨肺功能降低是否可预测糖尿病患者发生心血管疾病及全因死亡的风险。
研究方法：本研究纳入美国国家健康与营养检查调查（National Health and Nutrition Examination Survey, NHANES III）中的1723名成年糖尿病患者，受试者平均年龄为60.2岁。通过与截至2015年12月31日的数据库记录进行关联，确定受试者的死亡结局。采用Cox比例风险回归模型估算冠心病（coronary heart disease, CHD）、心血管疾病及全因死亡率的风险比（hazard ratios, HRs）与95%置信区间（95% confidence intervals, CIs）。并基于年龄、体重指数（body mass index, BMI）、高血压病史及血脂异常情况进行分层分析。
研究结果：平均随访14.62年（共计25184人年）期间，共记录到1221例死亡病例，其中327例死于冠心病、406例死于心血管疾病、197例死于癌症。经多因素校正后，一秒用力呼气容积（forced expiratory volume in one second, FEV1）与用力肺活量（forced vital capacity, FVC）水平较低的受试者，其发生冠心病、心血管疾病及全因死亡的风险显著升高。较低的用力肺活量水平与癌症死亡风险升高亦存在相关性[风险比：3.85（95%CI：1.31~11.32）；趋势检验P值=0.040]，但经协变量校正后，一秒用力呼气容积与癌症死亡的相关性有所减弱[风险比：2.23（95%CI：0.54~9.17）；趋势检验P值=0.247]。亚组分析显示，在按年龄、体重指数、高血压病史及血脂异常情况划分的亚组中，均观察到一秒用力呼气容积与用力肺活量水平降低对心血管疾病死亡的不良关联。
研究结论：在糖尿病患者中，肺功能下降与心血管疾病及全因死亡风险升高显著相关。应鼓励对糖尿病患者开展肺功能检测，尤其是一秒用力呼气容积与用力肺活量检测，以为糖尿病患者心血管疾病及全因死亡的管理提供预后与预测信息。