Pulmonary Function Decline and 17-Year Total Mortality: The Honolulu Heart Program

The Honolulu Heart Program continues to follow a cohort of Japanese-American men initially aged 45–68 years, of whom 4,000 had three acceptable measurements of forced expiratory volume in 1 second (FEV1) between 1965 and 1974 and were free of cardiovascular disease and cancer. The 6-year rate of change (slope) in FEV1 was calculated using a within-person linear regression method. Men were dMded into tertiles based on the rate of change in FEV1 During 17 subsequent years of follow-up, 796 deaths occurred. The tertile with the greatest rate of decHne in FEV1 (mean, −61 ml/year) had the highest age-adjusted total mortality rate (17.3/1,000 person-years), followed by rates of 13.2 for the middle tertile (mean, −25 ml/year) and 11.0 for men with the smallest change in FEV1 (mean, +9 ml/year) (test for trend, p 42 (RR = 1.56, 95% Cl 1.20–2.02), pack-year groups. An increased risk was also present for current smokers (RR = 1.29), but it was of borderline significance (p = 0.08). No association was found among never smokers. These data suggest that the rate of decline in FEV1 is a predictor of total mortality among smokers.