Association between rapid decline in lung function† as the predictor variable (between Coronary Artery Risk Development in Young Adults (CARDIA) Y20 and peak determined from the highest value at Y0, Y2, Y5 and Y10 visits) and incident, prevalent and persistent excess urinary albumin excretion (eUAE) as outcome variables (latter measured at Y20 and/or Y25 examination visits at a mean age of 45 or 50 years)
| eUAE as outcome | Incident (n=2844 for unadjusted model; n=2622 for adjusted model) | Prevalent (n=3052 for unadjusted model; n=2815 for adjusted model) | Persistent (n=2649 for unadjusted model; n=2459 for adjusted model) | Incident (n=2844 for unadjusted model; n=2622 for adjusted model) | Prevalent (n=3052 for unadjusted model; n=2815 for adjusted model) | Persistent (n=2649 for unadjusted model; n=2459 for adjusted model) |
| Rapid lung function decline as predictor† | FEV1 decline as predictor OR (95% CI) | FVC decline as predictor OR (95% CI) | ||||
| Unadjusted model | 1.34* (1.03 to 1.74) | 1.45** (1.12 to 1.88) | 1.99** (1.38 to 2.88) | 1.46* (1.13 to 1.90) | 1.73** (1.34 to 2.24) | 2.27** (1.57 to 3.28) |
| Adjusted model‡ | 1.51** (1.17 to 1.95) | 1.51** (1.17 to 1.95) | 1.75* (1.14 to 2.68) | 1.44* (1.07 to 1.96) | 1.41* (1.09 to 1.83) | 1.56* (1.01 to 2.41) |
†Rapid decline was defined by the highest tertile of decline and compared with the lower two tertiles. Rapid FEV1 decline was defined by ≥52 mL/year. Rapid FVC decline was defined by ≥45.8 mL/year.
‡Multivariable model above was adjusted for standard covariates (ie, sex, enlarged waist circumference, diabetes mellitus, age, race, height, current smoking status, pack-year smoking history, physical activity) plus hypertension, change in BMI and peak FEV1 or FVC. Standard covariates were obtained at Y5 visit. Hypertension was measured at or before Y10; change in BMI was measured between Y0 and Y5; and peak FEV1 or FVC was determined from the highest FVC or FEV1 value at or before Y10. Additional adjustment for exploratory covariates, that is, change in BMI between Y0 and Y20, the sum of smoking pack-years over Y0 and Y20, fasting blood glucose levels at Y7 and self-reported asthma status at Y5, did not change the relationship between rapid decline in FEV1 or FVC and incident eUAE (online supplementary table E-VI).
Incident eUAE was defined as the new occurrence of excretion at Y20 or Y25 examination visits (at a mean age of 45 or 50 years) without antecedent excretion. Prevalent eUAE was defined as excretion at CARDIA Y20 and/or Y25, irrespective of antecedent excretion. Persistent eUAE was defined as excretion at Y25 plus at one or more measurements at Y10, Y15, or Y20.
*p≤0.05, **p≤0.001.
BMI, body mass index.