Association between preserved ratio impaired spirometry and cardiovascular disease subtypes: evidence from NHANES 2007–2012

Preserved ratio impaired spirometry (PRISm) is a distinct pulmonary function abnormality characterized by a diminished forced expiratory volume in one second (FEV1) while maintaining a normal FEV1/forced vital capacity ratio. Although PRISm is associated with cardiovascular disease (CVD), its correlation with CVD subtypes and multiple CVDs is unclear. This study aims to investigate the association between PRISm and single and multiple CVDs using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2012 and explore the heterogeneity of this association in specific CVD subtypes, including coronary heart disease, heart failure, stroke, angina, and heart attack. We included 8258 participants aged ≥ 20 years from NHANES 2007–2012. We utilized multivariable logistic regression to adjust for confounders in four stages (demographic factors, lifestyle factors, and metabolic diseases) to analyze the association between PRISm and the number of CVDs (1, ≥ 2, and ≥ 3) and specific subtypes (coronary heart disease, heart failure, stroke, angina, and heart attack). Additionally, we performed subgroup and sensitivity analyses. The prevalence of PRISm was 13.99%. Participants with PRISm were older and exhibited a higher prevalence of obesity, hypertension, and diabetes ( p< 0.001). Upon complete adjustment, PRISm was significantly associated with multiple CVDs (≥ 2) (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.27–3.78), CVDs (≥ 3) (OR: 2.10, 95% CI: 1.06–4.16) and exhibited the most pronounced association with heart failure (OR: 2.60, 95% CI: 1.40–4.86); however, not with stroke (p= 0.670). Subgroup analyses revealed that the risk of heart failure was higher in men and in participants with a body mass index < 30 kg/m2 (OR: 4.19 and 3.40, respectively). PRISm is independently associated with multiple CVDs, particularly heart failure. Clinicians may consider cardiovascular risk monitoring in PRISm patients given this robust association