Assessment of Vascular Function in Patients with Chronic Lung Disease

• Research type

  Research Study

• Full title

  Assessment of Vascular Function in Patients with Chronic Lung Disease

• IRAS ID

  300082

• Contact name

  Faisel Khan

• Contact email

  f.khan@dundee.ac.uk

• Sponsor organisation

  University of Dundee

• Duration of Study in the UK

  3 years, 0 months, 1 days

• Research summary

  Summary of Research

  Recent studies have shown that patients who have bronchiectasis are at risk of developing cardiovascular disease, which is independent of the smoking state or other cardiovascular risk factors. This study's primary aim is to evaluate endothelial dysfunction and arterial stiffness in patients who have bronchiectasis. Additionally, the aim is to conduct a laboratory investigation on the underlying mechanisms of action that link the systemic inflammatory and oxidative stress biomarkers with developed endothelial dysfunction and arterial stiffness among patients with bronchiectasis. We hypothesise that assessment of vascular function and laboratory tests evaluation will be adding new knowledge to the literature and can be a key role to link it to the systemic inflammatory and oxidative stress biomarkers among patients who have bronchiectasis; providing key data for the development of new therapies and targeting of existing therapies to the appropriate patient groups. This cohort study aims to recruit 80 patients with bronchiectasis, 40 with COPD and 40 health volunteers; looking for the incidence of endothelial dysfunction among patients who have bronchiectasis in comparison to COPD and control healthy volunteers. Vascular tests such as laser perfusion imaging with iontophoresis, EndoPAT (to measure endothelial function) and sphygmoCor (to assess arterial stiffness) will be performed in all groups to determine the health of the blood vessels. Moreover, we will screen blood borne oxidative stress and inflammatory biomarkers such as Nrf2.

  Summary of Results
  Background Chronic lung diseases (CLD) like asthma, chronic obstructive pulmonary disease (COPD), and bronchiectasis are long-term conditions that affect breathing and lung function. These diseases are not only complex and varied, but they also often come with other health problems—especially those related to the heart and blood vessels.
  Doctors and researchers have noticed that people with CLD often suffer from heart-related issues, such as heart attacks and problems with blood circulation. But the reasons behind this connection haven’t been fully understood. One possible explanation is systemic inflammation, which means inflammation that affects the whole body, not just the lungs.
  Inflammation can damage the endothelium, the thin layer of cells lining the blood vessels. This layer plays a key role in controlling blood flow, blood pressure, and how the body responds to injury or infection. When the endothelium doesn’t work properly—a condition known as endothelial dysfunction—it can lead to atherosclerosis (hardening of the arteries) and arterial stiffness, both of which increase the risk of heart disease.
  Several factors can contribute to this damage, including aging, high cholesterol, high blood sugar, high blood pressure, lack of exercise, obesity, smoking, and chronic inflammation. Because these issues are common in people with CLD, we wanted to explore how inflammation in the lungs might be affecting the heart and blood vessels.

  Study Goals
  The main aim of the study was to understand how inflammation in people with chronic lung disease contributes to problems in their blood vessels—specifically endothelial dysfunction and arterial stiffness. These are early warning signs of heart disease and can help predict future cardiovascular problems.

  How the Study Was Done
  We studied two groups of people:
  • 30 patients with chronic lung disease (asthma, COPD, or bronchiectasis)
  • 20 healthy individuals without lung disease
  We compared how well the participants’ blood vessels were working and looked at markers in the blood that indicate inflammation and oxidative stress (a type of cell damage caused by unstable molecules called free radicals).

  To measure blood vessel health, we used several advanced techniques:
  1. Pulse Wave Velocity (PWV) – to measure how stiff the arteries are.
  2. Laser Speckle Imaging and Iontophoresis – to assess how small blood vessels respond to certain chemicals.
  3. Peripheral Arterial Tonometry (PAT) – to evaluate blood flow in the fingers, which reflects overall vascular health.
  We also analysed blood samples using specialized lab tests to detect 50 different markers related to inflammation and oxidative stress.

  Key Findings
  The study found clear differences between the CLD patients and the healthy individuals:
  1. Arterial Stiffness
  • People with CLD had significantly stiffer arteries.
  • Their PWV scores were higher (7.5 vs. 5.6 m/s), meaning their arteries were less flexible.
  • Their PWA scores (another measure of stiffness) were also higher (27.1% vs. 12.7%).
  2. Microvascular Function
  • The small blood vessels in CLD patients didn’t respond as well to chemicals that normally cause them to widen.
  • Blood flow was lower in response to acetylcholine and sodium nitroprusside, indicating microvascular dysfunction.
  3. Blood Biomarkers
  • Out of 50 markers tested, 24 showed significant differences between the two groups.
  • These included markers like Adiponectin, VCAM-1, GDF-15, and Coagulation Factor III, which are linked to inflammation and blood vessel health.
  • Even after adjusting for age, gender, body weight, and blood pressure, 15 markers remained significantly different, suggesting a strong link between CLD and vascular problems.

  What This Means
  The study confirms that people with chronic lung disease are more likely to have problems with their blood vessels, even if they don’t yet show symptoms of heart disease. These problems are likely caused by systemic inflammation, which affects both the lungs and the cardiovascular system.

  This inflammation damages the endothelium and makes the arteries stiffer, which increases the risk of heart attacks, strokes, and other cardiovascular events. The findings suggest that monitoring blood vessel health in CLD patients could help doctors identify those at higher risk and take steps to prevent heart disease.

  Why It Matters
  This research highlights the importance of treating chronic lung disease as a condition that affects more than just the lungs. It shows that:
  • Heart health should be a priority in people with CLD.
  • Inflammation is a key link between lung disease and cardiovascular problems.
  • Early detection of blood vessel issues could lead to better outcomes.

  By understanding these connections, healthcare providers can develop better strategies to manage CLD and reduce the risk of heart disease. This might include:
  • Anti-inflammatory treatments
  • Lifestyle changes (like diet and exercise)
  • Regular monitoring of blood vessel health

  Conclusion
  In summary, this study provides strong evidence that chronic lung diseases like asthma, COPD, and bronchiectasis are closely linked to heart and blood vessel problems. The connection is driven by systemic inflammation, which damages the blood vessels and increases the risk of cardiovascular events. By identifying and managing these risks early, doctors can help improve both lung and heart health in patients with CLD. This research opens the door to new treatments and better care for people living with these challenging conditions.

• REC name

  North of Scotland Research Ethics Committee 2

• REC reference

  22/NS/0002

• Date of REC Opinion

  7 Feb 2022

• REC opinion

  Further Information Favourable Opinion