• Respiratory Measurement

The intimately connected physiology of the cardiovascular and pulmonary systems gives rise to numerous shared risk factors and disease pathways, contributing significantly to the high incidence of co-occurring heart and lung diseases.1 For example, individuals diagnosed with asthma are at 15%–53% higher risk of cardiovascular disease (CVD),2 while those diagnosed with chronic obstructive pulmonary disease (COPD) have 2–5 times higher CVD risk.3 The association between respiratory impairment and CVD is not restricted to individuals with diagnosed respiratory conditions. Indeed, several studies have shown that impaired lung function, regardless of diagnosis, is associated with heightened CVD risk.4 5

However, the implications of such associations for clinical practice and policymaking have remained underexplored. Multivariable risk prediction is the cornerstone of primary prevention of CVD.6 For instance, statin therapy and lifestyle modifications are recommended for individuals without history of CVD when their predicted 10-year risk of CVD exceeds 5%–10%.7 Risk prediction is based on traditional risk factors including age, smoking history, blood pressure and serum lipids. The relevance of lung function measures in CVD risk estimation depends on the degree by which lung function remains a predictor of CVD, over and beyond the risk predicted by a scoring tool.

This important question was tackled by the study by Zhou et al, published in this issue of Thorax.8 Compared with previous studies,5 9 this study provides unique insights into …