PULMONARY-FUNCTION DECLINE AND 17-YEAR TOTAL MORTALITY - THE HONOLULUHEART PROGRAM

The Honolulu Heart Program continues to follow a cohort of Japanese-Am erican men initially aged 45-68 years, of whom 4,000 had three accepta ble measurements of forced expiratory volume in 1 second (FEV(1)) betw een 1965 and 1974 and were free of cardiovascular disease and cancer. The 6-year rate of change (slope) in FEV(1) was calculated using a wit hin-person linear regression method. Men were divided into tertiles ba sed on the rate of change in FEV(1). During 17 subsequent years of fol low-up, 796 deaths occurred. The tertile with the greatest rate of dec line in FEV(1) (mean, -61 ml/year) had the highest age-adjusted total mortality rate (17.3/1,000 person-years), followed by rates of 13.2 fo r the middle tertile (mean, -25 ml/year) and 11.0 for men with the sma llest change in FEV(1) (mean, +9 ml/year) (test for trend, p < 0.0001) . Using the Cox model, comparing the tertile with the smallest change in FEV(1) as a reference group with the tertile with the greatest decl ine in FEV(1), and after adjusting for age, hypertension, smoking, bod y mass index, alcohol intake, diabetes mellitus, and cholesterol, the authors found the relative risk (RR) for total mortality to be 1.48 (9 5% confidence interval (CI) 1.24-1.77). After stratification by smokin g status, this association remained significant for past smokers (RR = 1.79, 95% CI 1.31-2.14), as well as for the low, less than or equal t o 42 (RR = 1.46, 95% CI 1.05-2.03), and high, >42 (RR = 1.56, 95% CI 1 .20-2.02), pack-year groups. An increased risk was also present for cu rrent smokers (RR = 1.29), but it was of borderline significance (p = 0.08). No association was found among never smokers. These data sugges t that the rate of decline in FEV(1) is a predictor of total mortality among smokers.