The association between lung function and fatal stroke in a community followed for 4 decades
- Anne Kristine Gulsvik1,
- Amund Gulsvik2,
- Eva Skovlund3,
- Dag Steinar Thelle4,
- Morten Mowé5,
- Sjur Humerfelt6,
- Torgeir Bruun Wyller1
- 1Department of Geriatric Medicine Ullevaal, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
- 2Department of Thoracic Medicine, Institute of Medicine, University of Bergen, Bergen, Norway
- 3Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway
- 4Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- 5Department of General Internal Medicine, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
- 6Department of Thoracic Medicine, Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway
- Correspondence to Dr Anne Kristine Gulsvik, Department of Geriatric Medicine Ullevaal, Institute of Clinical Medicine, Oslo University Hospital University of Oslo, 0424 Oslo, Norway;
- Accepted 26 February 2012
- Published Online First 7 April 2012
Background Previous studies, all of <20 years of follow-up, have suggested an association between lung function and the risk of fatal stroke. This study investigates the stability of this association in a cohort followed for 4 decades.
Methods The Bergen Clinical Blood Pressure Survey was conducted in Norway in 1964–1971. The risk of fatal stroke associated with forced expiratory volume after one second (FEV1) was estimated with Cox proportional hazards regression, making progressive adjustment for potential confounders.
Results Of 5617 (84%) participants with recorded baseline FEV1, 462 died from stroke over 152 786 subsequent person-years of follow-up according to mortality statistics of 2005; mean (SD) follow-up was 27 (12) years. An association between baseline FEV1 (L) and fatal stroke was observed; HR=1.38 (95% CI 1.11 to 1.71) and HR=1.62 (95% CI 1.22 to 2.15) for men and women, respectively (adjusted for age and height). The findings were not explained by smoking, hypertension, diabetes, atherosclerosis, socioeconomic status, obstructive lung disease, physical inactivity, cholesterol or body mass index and persisted in subgroups of never-smokers, subgroups without respiratory symptoms and survivors of the first 20 years of follow-up. For male survivors with a valid FEV1 at follow-up (1988–1990) (n=953), baseline FEV1 (L) indicated a possible strong and independent association to the risk of fatal stroke after adjustments for individual changes in FEV1 (ml/year) (HR 1.95 (95% CI 0.98 to 3.86)).
Conclusion There is a consistent, independent and long-lasting association between lung function and fatal stroke, probably irrespective of changes during adult life.
- Cerebrovascular disease
- long-term studies
- lung function
- risk factors
Funding The University of Oslo supported the research reported in this paper. The Norwegian Council for Cardiovascular Disease, the WHO and the Research Foundation for Thoracic Medicine, University of Bergen, Norway, gave financial support for the Clinical Survey in Bergen in 1964–1971, data management and quality controls of the files.
Competing interests None.
Ethics approval Ethics approval was provided by Oslo, Norway.
Provenance and peer review Not commissioned; externally peer reviewed.