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

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.

To systematically report existing methods of estimating ASCVD risk in chronic respiratory disease populations, highlighting strengths, limitations and clinical applicability.

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.

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.

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.