Correlates and assessment of excess cardiovascular risk in bronchiectasis

What is it about?

Bronchiectasis is a chronic lung disease which occurs for various causes and results in a productive cough, frequent, often severe, chest infections and progressive lung damage with breathlessness. Current treatment is mainly based on alleviating symptoms and treating chest infections (exacerbations) or trying to reduce their frequency using antibiotics. It is increasing recognised that, as with some other chronic inflammatory diseases, patients with bronchiectasis suffer from more heart attacks and strokes than those without. Previous studies have shown that patients with bronchiectasis have stiffer arteries than healthy subjects of similar ages. This may result from chronic systemic inflammation and contribute to the excess in heart attacks and strokes. We performed an observational study to quantify the excessive arterial stiffness using pulsewave velocity, a non-invasive measurement, as well as blood markers correlating with inflammation and cardiovascular risk. We then aimed to identify aspects of bronchiectasis severity correlating with stiffer arteries and raised blood markers. Finally, we compared the excess risk of heart attacks and strokes that we calculated using arterial stiffness measurements against estimates of risk we derived in the same patients using QRISK2, a standardised risk measurement tool based on a number of commonly measured data. QRISK2 does not factor in the presence of bronchiectasis. We found that patients with bronchiectasis had greater arterial stiffness than reported from populations of healthy individuals of the same age. Patients with more frequent bronchiectasis exacerbations and lower lung function had most elevated arterial stiffness and inflammatory blood markers. Finally, cardiovascular risk estimates were significantly greater when based on arterial stiffness than when calculated according to QRISK2. Our data suggest that QRISK2 may underestimate cardiovascular risk in patients with bronchiectasis particularly those with frequent exacerbations. These findings add a further motivation to reduce the frequency of bronchiectasis exacerbations as they may carry a cardiovascular risk as well as progressing lung damage and severely affecting quality of life.

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