Late Breaking Abstract - Low Lung Function, Sudden Cardiac Death and Non-Fatal Coronary Events in the General Population

Background: Many of those who suffer from a first acute coronary event (CE) die suddenly during the day of the event. Poor lung function is a strong predictor of future cardiac events, however it is unknown whether the pattern of lung function impairment differs for the prediction of sudden cardiac death (SCD) vs non-fatal coronary events (CE). Aim: We examined measures of lung function in relation to future SCD and non-fatal CE in a population-based study. Methods: Baseline spirometry was assessed in 28,584 middle–aged subjects, without previous history of CE from the Malmö Preventive Project. The cohort was followed prospectively for incidence of SCD (death on day of a first CE, in/outside hospital) or non-fatal CE (CE survived the first day). A modified version of Lunn McNeil’s competing risks method was used to run both Cox regression models simultaneously. Results: A 1-standard deviation (SD) reduction in FEV1 was more strongly associated with SCD than non-fatal CE after full adjustments (Hazard ratio (HR) for SCD: 1.23 (1.15-1.31), HR for non-fatal CE 1.08 (1.04-1.13), p-value for equal associations=0.002). Similar associations were found for a 1-SD reduction in FVC but not FEV1/FVC. The results remained significant even in life-long never-smokers (1-SD reduction in FEV1: HR for SCD: 1.34 (1.15-1.55), HR for non-fatal CE: 1.11 (1.02-1.21), p-value for equal associations=0.038) Conclusion: Low FEV1 is associated with both SCD and non-fatal CE, but consistently more strongly associated with future SCD. Measurement with spirometry in early life could aid in the risk stratification of future SCD. The results support the use of spirometry for global assessment of cardiovascular risk