It is unclear whether the dose-response relationship between lung function and all-cause and cardiovascular mortality in the Central and Eastern European populations differ from that reported in the Western European and American populations. We used the prospective population-based HAPIEE cohort that includes randomly selected people with a mean age of 59 ± 7.3 years from population registers in Czech, Polish, Russian and Lithuanian urban centres. The baseline survey in 2002-2005 included 36,106 persons of whom 24,944 met the inclusion criteria. Cox proportional hazards models were used to estimate the dose-response relationship between lung function defined as FEV1 divided by height cubed and all-cause and cardiovascular mortality over 11-16 years of follow-up. Mortality rate increased in a dose-response manner from highest to lower FEV1/height3 deciles. Adjusted hazard ratios (HR) of all-cause mortality for persons in the 8th best, the 5th and the worst deciles were 1.27 (95% CI 1.08‒1.49), 1.37 (1.18-1.60) and 2.15 (1.86‒2.48), respectively; for cardiovascular mortality, the respective HRs were 1.84 (1.29-2.63), 2.35 (1.67-3.28) and 3.46 (2.50‒4.78). Patterns were similar across countries, with some statistically insignificant variation. FEV1/height3 is a strong predictor of all-cause and cardiovascular mortality, across full distribution of values, including persons with preserved lung function.

Department of Epidemiology and Population Sciences Institute of Public Health Jagiellonian University Medical College Kraków Poland

Faculty of Science Research Centre for Toxic Compounds in the Environment Masaryk University Kotlarska 2 Brno Czech Republic

Laboratory of Population Research Institute of Cardiology Lithuanian University of Health Sciences Kaunas Lithuania

National Institute of Public Health Prague Czech Republic

Novosibirsk State Medical University Novosibirsk Russia

Research Department of Epidemiology and Public Health University College London London UK

Research Institute of Internal and Preventive Medicine Institute of Cytology and Genetics Siberian Branch of the Russian Academy of Sciences Novosibirsk Russia

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Can spirometry improve the performance of cardiovascular risk model in high-risk Eastern European countries?