Centre for Inflammation and Tissue Repair, UCL Respiratory Medicine, Royal Free Campus, University College London, London, UK
Centre for Inflammation and Tissue Repair, UCL Respiratory Medicine, Royal Free Campus, University College London, London, UK.
Eur Respir J. 2017 Nov 22;50(5). doi: 10.1183/13993003.01127-2017. Print 2017 Nov.
Patients with bronchiectasis are at increased risk of cardiovascular disease. We aimed to identify factors associated with elevated cardiovascular risk in bronchiectasis, measured using aortic stiffness and cardiac biomarkers. In addition, we sought to compare these direct measures against calculated QRISK2 scores.Aortic stiffness, cardiac biomarkers and systemic inflammation were measured in 101 adults with stable bronchiectasis. In addition, clinical and demographic data were collected to allow calculation of QRISK2 score and the bronchiectasis severity index (BSI) for each patient.The BSI score correlated with measured cardiovascular risk assessments, partly due to greater exacerbation frequency and lower forced expiratory volume in 1 s. Pulse-wave velocity was significantly higher in frequent exacerbators (≥3 events·year) than infrequent exacerbators (<3 events·year; 10.5 9.2 m·s, p=0.01). In addition, frequent exacerbators had elevated serum C-reactive protein concentration, suggesting increased systemic inflammation (4.8 2.2 mg·L, p=0.005). QRISK2 systematically underestimated cardiovascular risk in this population (median change in relative risk 1.29). Underestimation was associated with frequent exacerbations and male sex.Patients with bronchiectasis have greater cardiovascular risk than published reference populations. Excess cardiovascular risk is associated with exacerbation frequency and impaired lung function. Cardiovascular risk assessment in bronchiectasis should be individualised, as calculation tools are likely to underestimate the risk in this population.
患有支气管扩张症的患者心血管疾病风险增加。我们旨在确定与支气管扩张症相关的升高心血管风险的因素，这些因素通过主动脉僵硬和心脏生物标志物来测量。此外，我们还试图将这些直接测量值与计算的 QRISK2 评分进行比较。在 101 名稳定的支气管扩张症成人中测量了主动脉僵硬、心脏生物标志物和全身炎症。此外，收集了临床和人口统计学数据，以便为每个患者计算 QRISK2 评分和支气管扩张症严重指数（BSI）。BSI 评分与测量的心血管风险评估相关，部分原因是加重频率更高和 1 秒用力呼气量（FEV1）更低。频繁加重者（≥3 次·年）的脉搏波速度明显高于不频繁加重者（<3 次·年；10.5 9.2 m·s，p=0.01）。此外，频繁加重者的血清 C 反应蛋白浓度升高，表明全身炎症增加（4.8 2.2 mg·L，p=0.005）。QRISK2 在该人群中系统地低估了心血管风险（相对风险的中位数变化为 1.29）。低估与频繁加重和男性性别有关。患有支气管扩张症的患者比已发表的参考人群具有更大的心血管风险。过多的心血管风险与加重频率和肺功能受损有关。在支气管扩张症中，心血管风险评估应个体化，因为计算工具可能会低估该人群的风险。
