RAPID DECLINE IN FEV(1) - A NEW RISK FACTOR FOR CORONARY HEART-DISEASE MORTALITY

Coronary heart disease (CHD) is the leading cause of mortality in the United States. The present cohort study was conducted to determine whe ther rate of FEV(1) loss independently predicts CHD mortality in appar ently healthy men. White male Baltimore Longitudinal Study of Aging (B LSA) participants without CHD underwent clinical evaluation at 2-yr in tervals; 883 had satisfactory pulmonary and lipid studies and returned for a least one visit. Cases were BLSA subjects without CHD on entry who died a ''coronary death'' (death from acute myocardial infarction, sudden death, or congestive heart failure in the presence of coronary artery disease). Forced expiratory maneuvers followed American Thorac ic Society guidelines. Serum cholesterol, blood pressure, cigarette sm oking, and body mass index were obtained from the BLSA database. There were 79 CHD deaths and 804 survivors during an average follow-up of 1 7.4 yr. After adjustment for age, initial FEV(1)% predicted, smoking s tatus, hypertension, and cholesterol, a time-dependent proportional ha zards model showed that cardiac mortality, but not all causes of morta lity, generally increased with increasing quintile of FEV(1) decline f or the entire cohort (relative risk [RR] 2.92-5.13) and separately for the subset of never-smokers. Thus, excess CHD mortality follows a lar ge decline in FEV(1), independent of the initial FEV(1)% predicted, ci garette smoking, and other common CHD risk factors.