BACKGROUND: Obstructive lung diseases carry a significant burden of cardiovascular comorbidity. This comorbidity is well studied in COPD but few studies to date have examined it within the context of bronchiectasis.INTRODUCTION: Bronchiectasis patients have greater cardiovascular risk compared to controls but the determinants are unclear. We aimed to assess cardiovascular risk in patients with bronchiectasis using serum cardiac biomarkers and aortic stiffness and assess whether measured risk was accurately calculated by the QRISK2 score. We also sought to identify factors significantly associated with cardiovascular risk in bronchiectasis.METHOD: We measured aortic stiffness (pulsewave velocity), cardiac and inflammatory biomarkers in 101 patients with stable (non cystic fibrosis) bronchiectasis. We compared measured cardiovascular risk to risk calculated using the QRISK 2 score, and identified features associated with higher risk.RESULTS: The composite bronchiectasis severity index (BSI) correlated with measured cardiovascular risk assessments. Aortic stiffness was significantly higher in frequent (³3 /year) exacerbators (10.5 vs 9.2 m/s, p=0.01). The QRISK2 score under-estimated cardiovascular risk in patients with bronchiectasis (median relative risk change= 1.29). Risk was particularly underestimated in frequent exacerbators and males.CONCLUSION: We confirm excess cardiovascular risk in bronchiectasis. This excess risk is associated with exacerbation frequency and impaired lung function. The QRISK2 calculator underestimates risk in bronchiectasis – especially in men and frequent exacerbators. Risk assessment in bronchiectasis should be individualised and not rely on standardised calculators.