{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T10:50:43Z","timestamp":1776423043560,"version":"3.51.2"},"reference-count":48,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T00:00:00Z","timestamp":1763164800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/W029790\/1"],"award-info":[{"award-number":["MR\/W029790\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"accepted":{"date-parts":[[2025,9,24]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic respiratory diseases (CRDs) and cardiovascular diseases (CVDs) are leading global health burdens. Despite being common, CRD and CVD comorbidity is often underestimated due to overlapping symptoms and risk factors. Consequently, their relationship remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims and objectives<\/jats:title>\n                    <jats:p>To determine the bidirectional genetic relationship between CRD and CVD and explore smoking and inflammation as potentially shared joint risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted bidirectional Mendelian randomisation (MR) to explore CRD\u2013CVD relationships. Summary statistics from genome-wide association studies were retrieved for chronic obstructive pulmonary disease (COPD), asthma, coronary artery disease (CAD), myocardial infarction (MI), heart failure, atrial fibrillation (AF) and ischaemic stroke (IS). We performed additional analysis including univariable MR for smoking, multivariable MR adjusting for smoking and cis-MR to investigate the role of inflammatory markers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Our MR analysis found limited genetic evidence of relationships between CRD and CVD, and vice versa. However, a nominally significant genetic association was observed between asthma and an increased risk of AF (OR inverse-variance weighted (OR\n                      <jats:sub>IVW<\/jats:sub>\n                      ) 1.036, 95%\u2009CI 1.003 to 1.070), remaining weakly significant after adjusting for smoking (OR\n                      <jats:sub>IVW<\/jats:sub>\n                      1.040, 95%\u2009CI 1.008 to 1.074). Genetically predicted lifetime smoking strongly increased all CRD and CVD risk. Additionally, genetically proxied IL6R concentration associated with increased asthma risk and decreased CAD, MI, AF and IS risk, while IL1RN decreased COPD risk but increased CAD and MI risk.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While we found limited genetic evidence linking CRD and CVD, smoking and inflammatory markers commonly affect both. These findings highlight the complexity of CRD\u2013CVD comorbidities, whose pathophysiology likely does not involve direct causation of each other.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/thorax-2024-222908","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T16:02:27Z","timestamp":1763395347000},"page":"447-456","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding the bidirectional relationship between chronic respiratory disease and cardiovascular disease using genetic evidence"],"prefix":"10.1136","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2038-6345","authenticated-orcid":false,"given":"Naesilla","family":"Naesilla","sequence":"first","affiliation":[{"name":"School of Public Health, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0149-4869","authenticated-orcid":false,"given":"Jennifer K","family":"Quint","sequence":"additional","affiliation":[{"name":"School of Public Health, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9827-1877","authenticated-orcid":false,"given":"Verena","family":"Zuber","sequence":"additional","affiliation":[{"name":"School of Public Health, Imperial College London, London, UK"},{"name":"MRC Centre for Environment and Health, Imperial College London, London, UK"},{"name":"UK Dementia Research Institute, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,15]]},"reference":[{"key":"2026041604050857000_81.5.447.1","doi-asserted-by":"crossref","first-page":"101936","DOI":"10.1016\/j.eclinm.2023.101936","article-title":"Global burden of chronic respiratory diseases and risk factors, 1990\u20132019: an update from the Global Burden of Disease Study 2019","volume":"59","author":"Momtazmanesh","year":"2023","journal-title":"eClinicalMedicine"},{"key":"2026041604050857000_81.5.447.2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)30925-9"},{"key":"2026041604050857000_81.5.447.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.11.010"},{"key":"2026041604050857000_81.5.447.4","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/S2213-2600(15)00241-6","article-title":"Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis","volume":"3","author":"Chen","year":"2015","journal-title":"Lancet Respir Med"},{"key":"2026041604050857000_81.5.447.5","first-page":"5081","article-title":"Bronchial asthma and risk of 4 specific cardiovascular diseases and cardiovascular mortality: a meta-analysis of cohort studies","volume":"26","author":"Hua","year":"2022","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2026041604050857000_81.5.447.6","doi-asserted-by":"crossref","first-page":"563","DOI":"10.2147\/COPD.S59962","article-title":"Prevalence of airflow limitation in outpatients with cardiovascular diseases in Japan","volume":"9","author":"Onishi","year":"2014","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2026041604050857000_81.5.447.7","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1007\/s12471-017-0965-4","article-title":"Impact of airflow limitation in chronic heart failure","volume":"25","author":"Bektas","year":"2017","journal-title":"Neth Heart J"},{"key":"2026041604050857000_81.5.447.8","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S378979"},{"key":"2026041604050857000_81.5.447.9","doi-asserted-by":"crossref","first-page":"14799731241242490","DOI":"10.1177\/14799731241242490","article-title":"The impact on thirty day readmissions for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease admitted to an observation unit versus an inpatient medical unit: A retrospective observational study","volume":"21","author":"Bell","year":"2024","journal-title":"Chron Respir Dis"},{"key":"2026041604050857000_81.5.447.10","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201203-0455PP"},{"key":"2026041604050857000_81.5.447.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.pharmthera.2019.02.013"},{"key":"2026041604050857000_81.5.447.12","doi-asserted-by":"crossref","unstructured":"Shin J , Yoon H-Y , Lee YM , et al . 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