Comparison of PRISm Phenotypes on Cardiovascular Disease Risk and Spirometry Trajectory: A Large Prospective Cohort Study.

Background: Emerging evidence indicated an association between preserved ratio impaired spirometry (PRISm) and cardiovascular disease (CVD) outcomes. However, the relationship between baseline characteristics, transitional trajectories of PRISm phenotypes, and CVD outcomes remains underexplored.

Methods: This study included 285,049 participants with spirometry measurements between 2006 and 2010, excluding those with preexisting CVD, including heart failure (HF), coronary heart disease (CHD), stroke, and those with airway obstruction (AO). Among them, 23,650 participants with follow-up spirometry (2014-2020) were analyzed for further pulmonary function transitions study.

Results: At baseline, restrictive (vs. non-restrictive) PRISm showed higher multivariate adjusted hazard ratios (HRs) of 1.20 (95% confidence interval [CI], 1.03-1.46) for HF, 1.05 (95% CI, 1.01-1.10) for stroke, and overall CVD events (HR = 1.10, 95% CI = 1.00-1.23). For spirometry transition trajectory, restrictive PRISm tended to remain stable, while non-restrictive PRISm often transitioned to other status over time. Moreover, normal to restrictive PRISm (HR = 1.71; 95% CI, 1.21-2.43), and normal to AO (HR = 1.45; 95% CI, 1.05-2.00) were associated with higher CVD risk compared to consistently normal spirometry.

Conclusions: Restrictive PRISm is more strongly associated with the development of CVD compared to non-restrictive PRISm and follows a distinct spirometry trajectory. Early intervention aimed at improving PRISm lung function may help mitigate the incidence of cardiovascular events.