What does this research mean for the field?

A wide variety of at least 68 different atherosclerotic cardiovascular risk assessment methods are used in chronic respiratory disease populations, reflecting a lack of standardized and validated approaches for this specific group. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 1, 2025European Respiratory Review1 citationsOpen Access

Methods to assess atherosclerotic cardiovascular risk in chronic respiratory diseases: a systematic review

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Chronic respiratory diseases. Intervention: Atherosclerotic cardiovascular risk assessment methods. Primary outcome: Identification and description of ASCVD risk assessment methods.

OUOmer Faruk UysalThe London College TJTobin JosephInterventional / Structural Cardiology AAAhmad M. AlharbiUniversity College London

Key Result

A systematic review of 63 studies identified 68 different atherosclerotic cardiovascular risk assessment methods used in chronic respiratory diseases, highlighting a lack of standardized, validated approaches.

Study Design

Type

Systematic Review

Structured PICO

Population

Adults (age ≥18 years) diagnosed with chronic respiratory diseases (including COPD, asthma, bronchiectasis, interstitial lung disease, emphysema, and chronic bronchitis) from 63 included studies.

Intervention

Atherosclerotic cardiovascular disease (ASCVD) risk assessment methods (including imaging-based techniques, arterial stiffness measures, risk scores, biomarkers, and haemodynamic assessments)

Outcome

Existing methods of estimating ASCVD risk, including their strengths, limitations, diagnostic accuracy, and clinical applicability

Multiple ASCVD risk assessment methods exist for patients with chronic respiratory diseases, but there is a critical need for validated, tailored approaches to improve personalized risk stratification.

Limitations

Inclusion of studies with diverse and often nonprospective designs limits the ability to evaluate predictive accuracy or prognostic utility
Reported sensitivity and specificity values were derived from heterogeneous populations, outcome definitions and study designs
Widely used methods such as QRISK3 and CAC scoring have not been specifically validated in CRD populations
Absence of a validated risk-of-bias tool for methodological evaluations
Lack of head-to-head comparisons and inconsistent outcome reporting hindered formal comparative analysis
Predominance of COPD-focused studies (90%) highlights a significant evidence gap in other chronic respiratory conditions

Abstract

BACKGROUND: Chronic respiratory diseases, such COPD and asthma, increase the risk of atherosclerotic cardiovascular disease (ASCVD) through shared pathophysiological mechanisms and modifiable risk factors. There are a number of methods to assess ASCVD, and limited systematic information about how these may be applied to chronic respiratory diseases. OBJECTIVE: To systematically report existing methods of estimating ASCVD risk in chronic respiratory disease populations, highlighting strengths, limitations and clinical applicability. METHODS: A systematic search of MEDLINE, Embase, Scopus, and CINAHL was conducted up to June 2025 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (www.crd.york.ac.uk/PROSPERO identifier CRD42024543335). An extended search was also performed. To assess search sensitivity, a random sample of 30 studies from the extended search were reviewed. Key international clinical guidelines were examined for recommended tools. Studies assessing ASCVD risk in chronic respiratory disease populations were included. A narrative synthesis was employed. RESULTS: 63 studies from 26 countries identified 68 ASCVD risk assessment tools and biomarkers in chronic respiratory disease. Imaging techniques such as coronary artery calcium scoring, and carotid intima-media thickness provide detailed anatomical information, but require equipment and expertise. Risk scores (Framingham Risk Score; Systematic Coronary Risk Evaluation) are practical, although they lack precision at the individual level. Biomarkers and functional tests provide holistic measurements yet are often resource-demanding. Arterial stiffness measurement directly assesses vascular pathology and requires specialist equipment. CONCLUSION: Multiple ASCVD risk assessment methods exist for chronic respiratory diseases, highlighting the need to understand the strengths and weaknesses of tools for tailored solutions. Future studies should address validation, accessibility and improved personalised risk stratification.

问 AI

Bookmark

View Full Paper