Arterial stiffness and wave reflection profiles in patients with asthma: the role of hemodynamic determinants

Asthma is a heterogeneous inflammatory airway disease increasingly recognised to be associated with elevated cardiovascular risk. Arterial stiffness, commonly assessed by pulse wave velocity (PWV), is a well-established predictor of cardiovascular events. However, it remains unclear whether vascular involvement in asthma reflects true arterial stiffening or predominantly altered arterial wave reflection.

To investigate arterial stiffness and wave reflection characteristics in patients with controlled and uncontrolled asthma compared with healthy controls.

Cross-sectional observational study.

A total of 158 participants (56 healthy controls, 50 patients with controlled asthma, and 52 patients with uncontrolled asthma) underwent non-invasive arterial stiffness and hemodynamic assessments. Peripheral and central blood pressures, PWV, augmentation pressure, augmentation index and reflection magnitude were measured. Group comparisons were performed using unadjusted analyses and multivariable analysis of covariance (ANCOVA). Multivariate analysis of covariance (MANCOVA) was used to evaluate wave reflection parameters simultaneously, adjusting for age, body mass index, smoking status, heart rate and systolic blood pressure.

PWV differed significantly between groups in unadjusted analyses, with higher values observed in asthma groups. However, this association was no longer significant after multivariable adjustment, with age and systolic blood pressure emerging as the strongest independent determinants of PWV. In contrast, MANCOVA revealed a significant overall group effect on wave reflection parameters. Subsequent univariate analyses demonstrated that reflection magnitude remained significantly higher in both controlled and uncontrolled asthma groups compared with healthy controls after adjustment, whereas augmentation pressure and augmentation index did not show independent group effects.

Vascular involvement in asthma appears to be characterised primarily by altered arterial wave reflection rather than overt arterial stiffening. These findings suggest that vascular alterations observed in asthma are primarily related to changes in arterial wave reflection and may be influenced by systemic hemodynamic factors (e.g. blood pressure and body composition), rather than asthma control itself.