CHEST Guidelines-Diabetes-and-Cardiovascular-Mortality-Among-Restri

Diabetes-and-Cardiovascular-Mortality-Among-Restri

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The article highlights findings from recent studies on the links between spirometry phenotypes and mortality, emphasizing the importance of examining lung function patterns beyond the normal FEV1/FVC ratio. It introduces two phenotypes: Preserved Ratio Impaired Spirometry (PRISm) and Restrictive Spirometric Pattern (RSP). PRISm is characterized by a normal FEV1/FVC ratio but impaired FEV1, while RSP involves an impaired FVC.

Key insights from research involving the Norwegian cohort of men and other studies are shared:

1. <strong>Phenotype Prevalence and Patterns:</strong> Around 7% of the Norwegian cohort displayed restrictive or mixed patterns similar to the Dutch study. PRISm and RSP often overlap, with patterns observed in separate groups akin to those identified in the Swedish SCAPIS study.

2. <strong>Health Outcomes:</strong> Studies have highlighted that PRISm alone is linked to those with respiratory issues and lifestyle factors like smoking. In contrast, RSP alone is more frequently associated with obesity and related complications. Cardiovascular mortality was notably higher in those with RSP than PRISm.

3. <strong>Role of Diabetes:</strong> RSP and mixed phenotypes have been associated with a sixfold increased mortality risk due to diabetes, unlike PRISm alone, which did not show a significant increase. The correlation between genetic susceptibilities related to lung function and type 2 diabetes risk was discussed.

4. <strong>Prognosis and Risk Factors:</strong> It’s noted that people with PRISm alone did not show increased cancer risk despite risk factors similar to those with obstructive patterns. Weight loss may reverse certain lung function impairments.

5. <strong>Conclusion:</strong> The studies affirm that spirometry can uncover hidden lung function issues linked to significant morbidity and mortality. Identifying and managing these patterns early in at-risk populations, such as through weight management and lifestyle modifications, is recommended to reduce risks.

Overall, the findings stress the need for targeted screening and interventions in people with preserved spirometric ratios but impaired lung function.

Keywords

spirometry

phenotypes

mortality

PRISm

RSP

lung function

Norwegian cohort

diabetes

cardiovascular mortality

screening