Compared with individuals with normal spirometry findings, the prevalence of ischemic heart disease (IHD) and heart failure (HF) is higher among those with chronic obstructive pulmonary disease (COPD) and preserved ratio impaired spirometry (PRISm), according to one study.

“Individuals with impaired spirometry findings, especially those with moderate or worse COPD and PRISm findings, have increased comorbid cardiovascular disease (CVD) compared with their peers with normal spirometry findings, and having COPD increases the risk of CVD developing,” wrote the researchers of this study.

To the researchers’ knowledge, this is the first study to describe the risk of CVD among individuals with diagnosed or undiagnosed COPD and PRISm findings. The full results of this observational cohort study were published in Chest.

The study was part of the Canadian Cohort Obstructive Lung Disease (CanCOLD) longitudinal study, which included a cohort of individuals with COPD, spirometry-conformed diagnosis, and matched non-COPD peers from 9 different cities across Canada: Vancouver, Calgary, Saskatoon, Toronto, Kingston, Ottawa, Montreal, Quebec, and Halifax.

Participants were evaluated at 4 visits, an initial visit between 2005 to 2016, and 3 visits between 2009 to 2019 over the duration of 3 to 10 years. At each visit, lung function and questionnaires were evaluated, while CVD variables used to calculate risk scores were obtained during the initial visit.

In total, the study enrolled 1561 participants. Of these participants, 726 had normal spirometry findings, 739 had spirometry-confirmed COPD, and 96 had PRISm findings. Most participants were White (95%) in their mid-sixties. Furthermore, 58% of the participants with COPD with COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage ≤ 2 and 84% with GOLD stage 1 had not received a diagnosis from their physicians.

As a result, the prevalence of IHD, odds ratio (OR, 1.66; 95% CI, 1.13-2.43; P = .01) or HF (OR, 1.55; 95% CI, 1.04-2.31; P = .033) was significantly higher among individuals with COPD and PRISm findings compared to those with normal spirometry, respectively.

Additionally, the prevalence of CVD was significantly higher in participants with PRISm findings and COPD GOLD stage ≤ 2, but not GOLD stage 1.

The incidence of CVD was also significantly higher in the impaired spirometry group, with hazard ratios (HR, 2.07; 95% CI, 1.10-3.91; P = .024) and (HR, 2.09; 95% CI, 1.10-3.98; P = .024) in the COPD group. This difference was significantly higher in participants with COPD GOLD stage ≤ 2, but not GOLD stage 1.

Furthermore, when adding spirometry status in the discrimination for predicting global CVD, no statistically significant differences were observed.

The researchers acknowledged some limitations to the study, including relying on self-reported CVD and the potential underreporting, misclassification, and recall bias of HF. Additionally, 21% of participants did not follow up or had died, which may have caused some CVD events to have been missed.

Despite limitations, the researchers believe the study provides evidence that individuals with COPD and PRISm findings are at higher risk of CVD compared to those with normal spirometry findings.

“Because these individuals with impaired spirometry are at higher risk of CVD, spirometry could help physicians to identify which individuals are at greatest risk so they may be offered preventive care,” concluded the researchers. “Cardiovascular risk scores should be evaluated further for how well they perform and how they can be improved in predicting CVD in this group.”


Krishnan S, Tan WC, Farias R, et al. Impaired spirometry and COPD increase the risk of cardiovascular disease. Chest. March 2023. doi:10.1016/j.chest.2023.02.045

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