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Small airways obstruction predicts cardiovascular disease incidence: a longitudinal study of UK Biobank

Sam Bartlett-Pestell1, Valentina Quintero Santofimio1, James Potts1

  • 1National Heart and Lung Institute, Imperial College London, London, UK.

ERJ Open Research
|June 10, 2026
PubMed

Insights

Isolated small airways obstruction (SAO) is linked to a modest increase in cardiovascular disease (CVD) risk. This association may be influenced by smoking, warranting further investigation into underlying mechanisms and mitigation strategies.

Area of Science:

  • Pulmonary Medicine
  • Cardiology
  • Epidemiology

Background:

  • Isolated small airways obstruction (SAO) is a common condition and a known precursor to chronic obstructive pulmonary disease (COPD).
  • SAO is also associated with increased mortality from cardiovascular disease (CVD).
  • The predictive value of isolated SAO for CVD incidence remains unclear.

Purpose of the Study:

  • To investigate whether isolated SAO predicts the incidence of cardiovascular disease (CVD).
  • To assess the association between isolated SAO and CVD incidence using a large UK Biobank cohort.
  • To explore potential differences in this association based on sex and smoking status.

Main Methods:

  • Longitudinal analysis of 139,568 UK Biobank participants.
  • Isolated SAO defined using FEV3/FEV6 < LLN with normal FEV1/FEV6, and alternatively using FEF25-75% < LLN with normal FEV1/FEV6.
  • Mixed effects quasi-Poisson regression models used to assess CVD incidence and its association with isolated SAO.

Main Results:

  • 7.5% of participants had isolated SAO at baseline.
  • During a median follow-up of 9.2 years, CVD was diagnosed in 22% of participants.
  • A modest increased risk of CVD was observed in individuals with isolated SAO (RR 1.05), particularly when defined by FEF25-75%, though not significant in males or never-smokers.

Conclusions:

  • Adults with isolated SAO exhibit a slightly elevated risk of developing CVD.
  • The observed association between SAO and CVD may be influenced by smoking status.
  • Further research is needed to elucidate the mechanisms behind this increased risk and develop effective mitigation strategies.
Abstract

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