Associations between accelerated lung function decline and cardiovascular outcomes: a systematic review

Background Emerging evidence suggests that lung function decline may be linked to cardiovascular disease (CVD), but this has not been synthesised to date. This review aims to synthesise the current evidence on accelerated lung function decline and cardiovascular outcomes. Methods We systematically searched MEDLINE, Embase and PubMed from inception to May 2026 for studies evaluating longitudinal changes in lung function in adults in relation to CVD. Study quality was assessed using the Risk Of Bias In Non-randomised Studies of Exposure tool, and findings were synthesised narratively. Findings Of 6772 studies identified from the search, 15 publications met the inclusion criteria: 12 general population cohorts, 2 occupational cohorts and 1 chronic obstructive pulmonary disease (COPD) cohort. In the general/occupational population, accelerated lung function decline was consistently associated with increased cardiovascular risk, with a uniformly positive directional trend and HRs ranging from 1.07 to 1.36 for forced expiratory volume in 1 s (FEV₁) and 1.06 to 1.33 for forced vital capacity. Similar trends were observed for CVD-related biomarkers, risk factors and subclinical cardiovascular phenotypes (eg, HRs 1.04–1.66 for accelerated FEV 1 decline). Potential effect modifiers of these associations such as smoking were reported. However, the association between accelerated lung function decline and CVD mortality in the general population remains inconclusive. In two occupational cohorts, lung function decline was associated with higher CVD mortality risk (HRs 2.05–2.59). Interpretation In ageing populations, tracking the rate of lung function decline may help identify not only those at risk of COPD but also those at risk of CVD.