Association of Cardiovascular Disease with Exacerbations, Longitudinal Lung Function Changes, and Spirometric Transitions in Preserved Ratio Impaired Spirometry
- 1Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China
Abstract
Background: Preserved ratio impaired spirometry (PRISm), defined as a post-bronchodilator forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio ≥0.70 with a post-bronchodilator FEV1 <80% predicted, is a heterogeneous spirometric pattern associated with adverse clinical outcomes and progression to chronic obstructive pulmonary disease (COPD). Cardiovascular disease (CVD) is a common comorbidity in PRISm, but its prognostic relevance for subsequent respiratory outcomes remains unclear. This study evaluated the association between baseline CVD and the longitudinal course of PRISm.
Methods: This retrospective cohort included 521 participants with PRISm identified between 2021 and 2023 and followed through 2025, with a mean follow-up duration of 2.59 ± 1.58 years. Participants were grouped according to baseline CVD status. Exacerbations, longitudinal lung function changes, spirometric transitions, and incident COPD were evaluated using multivariable logistic regression, linear mixed-effects models, and Cox proportional hazards models, as appropriate. Subgroup analyses were performed in restrictive and non-restrictive PRISm, with inverse probability of treatment weighting (IPTW) used for sensitivity analysis.
Results: Among 521 participants with PRISm, 166 had CVD. Compared with participants without CVD, those with CVD had a greater burden of severe and moderate-to-severe exacerbations, and a higher risk of frequent exacerbations (adjusted OR, 2.48; 95% CI, 1.13–5.47). Participants with CVD also experienced accelerated declines in FEV1, FVC, and their percent predicted values. They were more likely to progress to COPD and less likely to recover to normal spirometry. In the Cox proportional hazards analysis, baseline CVD was independently associated with incident COPD (adjusted HR, 1.63; 95% CI, 1.07–2.48). No significant interaction was observed between CVD status and PRISm subtype, and IPTW sensitivity analyses were consistent with the primary findings.
Conclusion: CVD was associated with greater exacerbation burden, faster lung function decline, and a higher risk of progression to COPD in individuals with PRISm. Assessment of CVD may provide additional information for risk stratification in PRISm; however, these observational findings require validation in prospective studies. Whether cardiovascular assessment can improve clinical outcomes in PRISm requires further investigation.
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BibTeX
@article{zhao2026association,
title = {{Association of Cardiovascular Disease with Exacerbations, Longitudinal Lung Function Changes, and Spirometric Transitions in Preserved Ratio Impaired Spirometry}},
author = {Ruobing Zhao and Yingxiang Lin},
journal = {International Journal of Chronic Obstructive Pulmonary Disease},
year = {2026},
month = oct,
doi = {10.2147/copd.s642374},
url = {https://doi.org/10.2147/copd.s642374},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Association of Cardiovascular Disease with Exacerbations, Longitudinal Lung Function Changes, and Spirometric Transitions in Preserved Ratio Impaired Spirometry
AU - Ruobing Zhao
AU - Yingxiang Lin
PY - 2026
DA - 2026/10/30
JO - International Journal of Chronic Obstructive Pulmonary Disease
DO - 10.2147/copd.s642374
UR - https://doi.org/10.2147/copd.s642374
AB - Background: Preserved ratio impaired spirometry (PRISm), defined as a post-bronchodilator forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio ≥0.70 with a post-bronchodilator FEV1 <80% predicted, is a heterogeneous spirometric pattern associated with adverse clinical outcomes and progression to chronic obstructive pulmonary disease (COPD). Cardiovascular disease (CVD) is a common comorbidity in PRISm, but its prognostic relevance for subsequent respiratory outcomes remains unclear. This study evaluated the association between baseline CVD and the longitudinal course of PRISm. Methods: This retrospective cohort included 521 participants with PRISm identified between 2021 and 2023 and followed through 2025, with a mean follow-up duration of 2.59 ± 1.58 years. Participants were grouped according to baseline CVD status. Exacerbations, longitudinal lung function changes, spirometric transitions, and incident COPD were evaluated using multivariable logistic regression, linear mixed-effects models, and Cox proportional hazards models, as appropriate. Subgroup analyses were performed in restrictive and non-restrictive PRISm, with inverse probability of treatment weighting (IPTW) used for sensitivity analysis. Results: Among 521 participants with PRISm, 166 had CVD. Compared with participants without CVD, those with CVD had a greater burden of severe and moderate-to-severe exacerbations, and a higher risk of frequent exacerbations (adjusted OR, 2.48; 95% CI, 1.13–5.47). Participants with CVD also experienced accelerated declines in FEV1, FVC, and their percent predicted values. They were more likely to progress to COPD and less likely to recover to normal spirometry. In the Cox proportional hazards analysis, baseline CVD was independently associated with incident COPD (adjusted HR, 1.63; 95% CI, 1.07–2.48). No significant interaction was observed between CVD status and PRISm subtype, and IPTW sensitivity analyses were consistent with the primary findings. Conclusion: CVD was associated with greater exacerbation burden, faster lung function decline, and a higher risk of progression to COPD in individuals with PRISm. Assessment of CVD may provide additional information for risk stratification in PRISm; however, these observational findings require validation in prospective studies. Whether cardiovascular assessment can improve clinical outcomes in PRISm requires further investigation.
SN - 1176-9106
SN - 1178-2005
ER -