FEV₁ is a stronger mortality predictor than FVC in patients with moderate COPD and with an increased risk for cardiovascular disease

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Bikov, Andras, Lange, Peter, Anderson, Julie A, Brook, Robert D, Calverley, Peter MA, Celli, Bartolome R, Cowans, Nicholas J, Crim, Courtney, Dixon, Ian J, Martinez, Fernando J et al (show 3 more authors) , Newby, David E, Yates, Julie C and Vestbo, Jorgen (2020) FEV₁ is a stronger mortality predictor than FVC in patients with moderate COPD and with an increased risk for cardiovascular disease. INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, 15. pp. 1135-1142.

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Abstract

<h4>Purpose</h4>Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Impaired lung function is associated with heightened risk for death, cardiovascular events, and COPD exacerbations. However, it is unclear if forced expiratory volume in one second (FEV₁) and forced vital capacity (FVC) differ in predictive value.<h4>Patients and methods</h4>Data from 16,485 participants in the Study to Understand Mortality and Morbidity (SUMMIT) in COPD were analyzed. Patients were grouped into quintiles for each lung function parameter (FEV₁ %predicted, FVC %predicted, FEV₁/FVC). The four highest quintiles (Q2-Q5) were compared to the lowest (Q1) to assess their relationship with all-cause mortality, cardiovascular events, and moderate-to-severe and severe exacerbations. Cox-regression was used, adjusted for age, sex, ethnicity, body-mass index, smoking status, previous exacerbations, cardiovascular disease, treatment, and modified Medical Research Council dyspnea score.<h4>Results</h4>Compared to Q1 (<53.5% FEV₁ predicted), increasing FEV₁ quintiles (Q2 53.5-457.5% predicted, Q3 57.5-461.6% predicted, Q4 61.6-465.8% predicted, and Q5 ≥65.8%) were all associated with significantly decreased all-cause mortality (20% (4-34%), 28% (13-40%), 23% (7-36%), and 30% (15-42%) risk reduction, respectively). In contrast, a significant risk reduction (21% (4-35%)) was seen only between Q1 and Q5 quintiles of FVC. Neither FEV₁ nor FVC was associated with cardiovascular risk. Increased FEV₁ and FEV₁/FVC quintiles were also associated with the reduction of moderate-to-severe and severe exacerbations while, surprisingly, the highest FVC quintile was related to the heightened exacerbation risk (28% (8-52%) risk increase).<h4>Conclusion</h4>Our results suggest that FEV₁ is a stronger predictor for all-cause mortality than FVC in moderate COPD patients with heightened cardiovascular risk and that subjects with moderate COPD have very different risks.

Item Type:	Article
Uncontrolled Keywords:	airflow limitation, cardiovascular risk, exacerbation, lung function, lung volumes, death rate
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	30 Jun 2021 09:54
Last Modified:	10 Oct 2023 06:04
DOI:	10.2147/COPD.S242809
Open Access URL:	http://doi.org/10.2147/COPD.S242809
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3128238