Lung Function Impairment and Risks of Incident Cardiovascular Diseases and Mortality Among People With Type 2 Diabetes: A Prospective Cohort Study

OBJECTIVE: Individuals with type 2 diabetes (T2D) frequently exhibit impaired lung function, potentially accelerating the onset of cardiovascular disease (CVD), although prospective studies remain limited. We aimed to explore the relationship between lung function impairment and risk of CVD and mortality within this high-risk population. RESEARCH DESIGN AND METHODS: This prospective study included 16,242 participants with T2D and free of CVD from the UK Biobank. Obstructive physiology (OP), restrictive physiology (RP), and preserved ratio impaired spirometry (PRISm) were defined using spirometry, including forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Fine-Gray subdistribution hazards models and Cox proportional hazards models were used to estimate risks of CVD and all-cause mortality, respectively. RESULTS: During a median follow-up of 13.9 years, 2,825 incident cases of CVD and 2,811 deaths were documented. Lower FEV1, FVC, FEV1/FVC ratio, FEV1 percent predicted, and FVC percent predicted were related to higher risks of CVD and all-cause mortality. Compared with preserved lung function, the adjusted subdistribution hazard ratios (HRs) for CVD were 1.19 (95% CI 1.05-1.35) for OP and 1.47 (95% CI 1.33-1.65) for RP. Compared with the control group, the subdistribution HRs for CVD were 1.20 (95% CI 1.06-1.36) for OP and 1.43 (95% CI 1.29-1.59) for PRISm. These associations were consistent across subgroups and sensitivity analyses. Adding lung function measurements significantly enhanced the performance of CVD prediction beyond the SCORE2-Diabetes model. CONCLUSIONS: Lung function impairment was associated with increased risks of CVD and all-cause mortality among individuals with T2D.