Small airways obstruction predicts cardiovascular disease incidence: a longitudinal study of UK Biobank
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Published version
Author(s)
Bartlett-Pestell, Samuel
Quintero Santofimio, Valentina
Potts, James
Fuertes, Elaine
Allinson, James
Type
Journal Article
Abstract
Background: Isolated small airways obstruction (SAO) is common, a precursor of chronic obstructive pulmonary disease, and is associated with increased cardiovascular disease (CVD) mortality. Whether isolated SAO predicts CVD incidence is unknown.
Methods: Using longitudinal data on 139,568 UK Biobank participants (median age 58 years), we calculated CVD incidence in those with, versus without, isolated SAO defined as FEV3/FEV6<LLN with a normal FEV1/FEV6 ratio. A second analysis was performed where isolated SAO was defined as FEF25-75% <LLN with a normal FEV1/FEV6 ratio. Using mixed effects quasi-Poisson regression models, we assessed the association between isolated SAO and CVD, investigating differences in association by sex and smoking status.
Results: At baseline, 10,480 participants (7.5%) had isolated SAO. During follow-up (median 9.2 years), CVD was diagnosed in 30,763 (22%) participants, more commonly among those with isolated SAO at baseline (RR = 1.05, 95% CI 1.01-1.09). This association was not significant in males (RR = 1.03, 95%CI 0.98-1.08) nor in never smokers (RR 1.02, 95%CI 0.97–1.09). The risk of CVD was increased when isolated SAO was defined using FEF25-75%.
Conclusions: Adults with isolated SAO have a modest increased risk of developing CVD. However, this association is potentially driven by smoking. Further research should explore underlying mechanisms for this increased risk and how best this can be mitigated.
Methods: Using longitudinal data on 139,568 UK Biobank participants (median age 58 years), we calculated CVD incidence in those with, versus without, isolated SAO defined as FEV3/FEV6<LLN with a normal FEV1/FEV6 ratio. A second analysis was performed where isolated SAO was defined as FEF25-75% <LLN with a normal FEV1/FEV6 ratio. Using mixed effects quasi-Poisson regression models, we assessed the association between isolated SAO and CVD, investigating differences in association by sex and smoking status.
Results: At baseline, 10,480 participants (7.5%) had isolated SAO. During follow-up (median 9.2 years), CVD was diagnosed in 30,763 (22%) participants, more commonly among those with isolated SAO at baseline (RR = 1.05, 95% CI 1.01-1.09). This association was not significant in males (RR = 1.03, 95%CI 0.98-1.08) nor in never smokers (RR 1.02, 95%CI 0.97–1.09). The risk of CVD was increased when isolated SAO was defined using FEF25-75%.
Conclusions: Adults with isolated SAO have a modest increased risk of developing CVD. However, this association is potentially driven by smoking. Further research should explore underlying mechanisms for this increased risk and how best this can be mitigated.
Date Issued
2026-05-01
Date Acceptance
2025-12-24
Citation
ERJ Open Research, 2026, 12 (3), pp.01190-2025
ISSN
2312-0541
Publisher
European Respiratory Society
Start Page
01190
End Page
2025
Journal / Book Title
ERJ Open Research
Volume
12
Issue
3
Copyright Statement
© The authors 2026 This version is distributed under the terms of the Creative Commons Attribution Non Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org
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Publication Status
Published
Date Publish Online
2026-06-08