Adults with current asthma but not former asthma have higher all-cause and cardiovascular mortality: a population-based prospective cohort study

Abstract

Higher mortality in asthmatics has been shown previously. However, evidence on different asthma phenotypes on long-term mortality risk is limited. The aim was to evaluate the impact of asthma phenotypes on mortality in general population. Data from the National Health and Nutrition Examination Survey from 2001–2002 to 2013–2014 linked mortality files through December 31, 2015, were used (N = 37,015). Cox proportional hazards regression was used to estimate the risk of all-cause and cause-specific mortality adjusting for sociodemographic characteristics, smoking, body mass index, and chronic conditions. During the mean follow-up time of 7.5 years, 4326 participants died from a variety of causes. Current asthma, but not former asthma was associated with increased all-cause mortality (current asthma: HR = 1.37; 95% CI 1.20–1.58; Former asthma: HR = 0.93; 95% CI 0.73–1.18); as well as mortality from cardiovascular disease (HRCurrent = 1.41; 95% CI 1.08–1.85) and chronic lower respiratory diseases (HRCurrent = 3.17; 95% CI 1.96–5.14). In addition, we found that the HR for cardiovascular disease (CVD) mortality was slightly greater in people with childhood-onset asthma than those with adult-onset asthma. The HR for chronic lower respiratory diseases (CLRD) mortality was greater in people with adult-onset asthma than those with childhood-onset asthma. However, the differences were not statistically significant. Our study suggested that current asthma but not former asthma was associated with increased all-cause, CLRD and CVD mortality. Future well-designed studies with larger sample are required to demonstrate the association and clarify the potential mechanisms involved.

Association Between Asthma and All-Cause Mortality and Cardiovascular Disease Morbidity and Mortality: A Meta-Analysis of Cohort Studies

“…Second, the inclusion criteria for asthma patients were one hospitalization, two outpatient visits, or two emergency department visits for asthma within 12 months, whereas most of the other studies based the inclusion criteria on questionnaires about self-reported asthma history. Thus, all of the asthma patients in that study had active and more severe asthma and, therefore, higher CVD morbidity and mortality risk than non-active asthma patients ( 37 , 40 ).…”

Bronchial Asthma as a Cardiovascular Risk Factor: A Prospective Observational Study

“…However, the evidence for ED in asthma is not as great as that in COPD [ 7 ]. ED is typically present in asthmatic adults [ 26 ]. Reduced flow-mediated dilatation (FMD) levels in asthmatics—a relation of FMD to asthma severity confirming a worsening endothelial function with disease progression—are also found in patients with COPD [ 27 ].…”

Meta-Analysis of the Association Between Asthma and the Risk of Stroke

“…After applying the inclusion and exclusion criteria, we included 18 observational studies (9, 14-30) (Figure 1). Among these, 2 studies (21,22) were identified in the manual search and 16 studies (9,(14)(15)(16)(17)(18)(19)(20)(23)(24)(25)(26)(27)(28)(29)(30) were identified in the electronic search.…”

“…Among 18 the observational studies included, 10 were crosssectional studies (21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Of these, 2 were cohort studies (21,28) that did not have outcomes of interest, but reported crosssectional data on the association between asthma and stroke in the baseline characteristics of the population. The other 8 cross-sectional cohort studies (9, 14-20) included 2 retrospective studies (17,19) and 6 prospective studies (9, 14-16, 18, 20).…”

“…Active asthma was defined as either a negative response to the question, "Do you still have asthma?" (14,21), or evidence that the patient had not recently used asthma medication (9,16). The risk of stroke was elevated in patients with active asthma (RR: 1.48, 95% CI: 1.12-1.95, p = 0.006; I 2 : 72%, p = 0.01), but not in patients with inactive asthma (RR: 0.95, 95% CI: 0.80-1.13, p = 0.58; I 2 : 10%, p = 0.34) (Figure 6).…”