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Respiratory muscle strength and the risk of incident cardiovascular events

¹ Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
² Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands
³ Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
⁴ Department of Biostatistics, University of Washington, Seattle, WA, USA
⁵ Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
⁶ Department of Pathology, University of Vermont, Colchester, VT, USA
⁷ College of Public Health, University of Arizona, Tucson, AZ, USA

Correspondence to:
Correspondence to:
Dr J van der Palen
Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands; vdpalen{at}euronet.nl

Background: Maximal inspiratory pressure (MIP) is a measure of inspiratory muscle strength. The prognostic importance of MIP for cardiovascular events among elderly community dwelling individuals is unknown. Diminished forced vital capacity (FVC) is a risk factor for cardiovascular events which remains largely unexplained.

Methods: MIP was measured at the baseline examination of the Cardiovascular Health Study. Participants had to be free of prevalent congestive heart failure (CHF), myocardial infarction (MI), and stroke.

Results: Subjects in the lowest quintile of MIP had a 1.5-fold increased risk of MI (HR 1.48, 95% CI 1.07 to 2.06) and cardiovascular disease (CVD) death (HR 1.54, 95% CI 1.09 to 2.15) after adjustment for non-pulmonary function covariates. There was a potential inverse relationship with stroke (HR 1.36, 95% CI 0.97 to 1.90), but there was little evidence of an association between MIP and CHF (HR 1.22, 95% CI 0.93 to 1.60). The addition of FVC to models attenuated the HR associated with MIP only modestly; similarly, addition of MIP attenuated the HR associated with FVC only modestly.

Conclusions: A reduced MIP is an independent risk factor for MI and CVD death, and a suggestion of an increased risk for stroke. This association with MIP appeared to be mediated through mechanisms other than inflammation.

Abbreviations: CHF, congestive heart failure; CVD, cardiovascular disease; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; MI, myocardial infarction; MIP, maximal inspiratory pressure; RV, residual volume

Keywords: respiratory muscles; cardiovascular disease; congestive heart failure; stroke; maximal inspiratory pressure

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