Associations of preserved ratio impaired spirometry with cardiometabolic comorbidities: a systematic review and meta-analysis

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Background Preserved ratio impaired spirometry (PRISm) is a prevalent lung function abnormality associated with an increased body mass index and an increased risk of cardiovascular disease and metabolic disorders. However, the strength and consistency of these associations across populations remain unclear. This systematic review and meta-analysis aimed to quantify the relationship between PRISm and key cardiometabolic comorbidities, including diabetes mellitus, hypertension, hypercholesterolaemia, ischaemic heart disease and heart failure. Methods A systematic search of PubMed, Embase and Web of Science was conducted to identify observational studies comparing the prevalence of cardiometabolic comorbidities in PRISm and normal spirometry populations. Meta-analyses were performed for conditions reported in three or more studies, and heterogeneity was assessed using the I 2 statistic. Sensitivity and influence analyses were conducted to ensure the robustness of findings. Results A total of 18 studies were included, comprising over 500 000 participants. Meta-analysis showed significant associations between PRISm and diabetes (OR 2.08, 95% CI 1.78–2.42), hypertension (OR 1.78, 95% CI 1.55–2.03), ischaemic heart disease (OR 2.05, 95% CI 1.59–2.64), heart failure (OR 2.82, 95% CI 1.40–5.67) and hypercholesterolaemia (OR 1.46, 95% CI 1.16–1.85). PRISm populations also exhibited a higher body mass index (mean difference 1.49 kg·m −2 , 95% CI 0.92–2.05 kg·m −2 ). Conclusion PRISm is strongly associated with cardiometabolic disease, reinforcing its role as a systemic condition rather than a purely pulmonary abnormality. These findings highlight the need for integrated screening and management strategies for PRISm patients to address their broader multimorbid risk profile.

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