“Shortness of breath is common in older adults and associated with higher risk of cardiovascular events. We therefore appropriately think about cardiac causes when an older patient complains of dyspnea,” Dr. Amil Shah of Brigham and Women’s Hospital in Boston told Reuters Health by email. “But many other factors – for example, decline in lung function, anemia, even depression – can contribute to shortness of breath.”
“We did this analysis to try to better understand the contribution of the cardiovascular system to dyspnea,” he said.
Dr. Shah and colleagues analyzed data from 4,342 participants (mean age, 76; 58% women) in the Atherosclerosis Risk in Communities study who attended the fifth visit (2011-2013) and did not have a diagnosis of heart failure, chronic obstructive pulmonary disease, morbid obesity or severe kidney disease, according to their JAMA Network Open report, online June 14.
Twenty-seven percent of participants had undifferentiated dyspnea that was moderate to severe in 13.2% Moderate to severe dyspnea was associated with left ventricular (LV) hypertrophy (odds ratio, 1.53) and LV diastolic (OR, 1.46) and systolic (OR, 1.28) dysfunction. It was also associated with obstructive and restrictive findings on spirometry (ORs, 1.59 and 2.56, respectively); renal impairment (OR, 1.32); anemia (OR, 1.72); lower and upper extremity weakness (ORs, 2.77 and 1.82), depression (OR, 3.01), and obesity (OR, 2.35).
After accounting for these conditions, moderate to severe dyspnea was associated with LV hypertrophy (OR, 1.30), but not with systolic or diastolic function.
In contrast, after adjustment for older age, female sex and black race – all of which were associated with increased dyspnea severity – other organ system measures (e.g., higher concentrations of NT-proBNP and high-sensitivity troponin) were associated with dyspnea, except for glomerular filtration rate and grip strength.
The population-attributable risk of dyspnea associated with obesity alone was 22.6% compared with 5.8% for LV hypertrophy.
“We think our results highlight that undifferentiated dyspnea in late life is commonly multifactorial, with non-cardiovascular contributors,” Dr. Shah said. “Clinicians should think broadly about potential causes and contributors to dyspnea in elders – including, but not limited to, the cardiovascular system.”
Cardiologist Dr. Robert Greenfield of MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, California, commented in an email to Reuters Health, “This article is a good reminder that an abnormal symptom such as shortness of breath can be caused by the interaction of multiple systems gone awry, and that multiple diagnoses need to be entertained, such as anemia, depression, or obesity and other organ dysfunction.”
JAMA Netw Open 2019.