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Review
. 2025 Oct 22;34(178):250050.
doi: 10.1183/16000617.0050-2025. Print 2025 Oct.

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

Omer Faruk Uysal  1 , Tobin Joseph  2   3 , Ahmad M Alharbi  4 , Tanya Patrick  4 , Aidan Yu  5 , Amar J Shah  4 , Swapna Mandal  4 , Siegfried K Wagner  6   7 , James Brown  4 , Chris P Gale  2   3   8 , John R Hurst  4
Affiliations
Review

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

Omer Faruk Uysal et al. Eur Respir Rev. .

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.

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Conflict of interest statement

Conflict of interest: O.F. Uysal reports support for the present study from Republic of Türkiye Ministry of National Education. T. Joseph and A.M. Alharbi have nothing to disclose. T. Patrick reports the following financial (or non-financial) interests: ongoing Clinical Research Fellowship funded by AstraZeneca by payment to institution (UCL). A. Yu, A.J. Shah, S. Mandal and S.K. Wagner have nothing to disclose. J. Brown reports grants from Asthma+Lung UK. C.P. Gale reports grants from Alan Turing Institute, British Heart Foundation, National Institute for Health Research, Horizon 2020, Abbott Diabetes, Bristol Myers Squibb and European Society of Cardiology; consultancy fees from AI Nexus, AstraZeneca, Amgen, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, CardioMatics, Chiesi, Daiichi Sankyo, GPRI Research B.V., Menarini, Novartis, iRhythm, Organon and The Phoenix Group; payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, Abbott, Inc., Bristol Myers Squibb, Boston Scientific, British Heart Foundation, National Institute of Health Research, Horizon 2020, European Society of Cardiology, Menarini, Novartis, Raisio Group, Wondr Medical and Zydus; support for attending meetings from AstraZeneca; participation on a data safety monitoring board or advisory board with DANBLCOK trial and TARGET CTCA trial; leadership roles as Deputy Editor of EHJ Quality of Care and Clinical Outcomes, on the NICE Indicator Advisory Committee and Chair of ESC Quality Indicator Committee; stock (or stock options) with CardioMatics, receipt of equipment, materials, drugs, medical writing, gifts or other services from Kosmos device; and other personal fees from Lung Health Foundation, Vifor Pharma and Oxford University Press. J.R. Hurst reports grants from AstraZeneca; consultancy fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Sanofi-Regeneron and Takeda; payment or honoraria for lectures, presentations, manuscript writing or educational events from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Sanofi-Regeneron, Sanofi and Takeda; and support for attending meetings from AstraZeneca.

Figures

FIGURE 1
FIGURE 1
Study selection flow diagram presented according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
See this image and copyright information in PMC

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