Asthma Predicts Cardiovascular Disease Events

Abstract

Objectives To identify and characterize an association between persistent asthma and cardiovascular disease (CVD) risk in the Multi-Ethnic Study of Atherosclerosis (MESA). Approach and Results MESA is a longitudinal prospective study of an ethnically diverse cohort of individuals free of known CVD at its inception. Presence and severity of asthma were assessed in the MESA at Exam 1. Persistent asthma was defined as asthmatics using controller medications (inhaled corticosteroids, leukotriene inhibitors, oral corticosteroids) and intermittent asthma as asthmatics not using controller medications. Participants were followed for a mean (standard deviation) 9.1 (2.8) years for development of incident CVD (coronary death, myocardial infarction, angina, stroke, and CVD death). Multivariable Cox regression models were used to assess associations of asthma and CVD. The 6,792 participants were 62.2 (standard deviation 10.2) years old: 47% male (28% African-American, 22% Hispanic, 12% Chinese). Persistent asthmatics (N=156), compared to intermittent (N=511) and non-asthmatics (N=6125), respectively had higher C-reactive protein (1.2 [1.2] vs 0.9 [1.2] vs 0.6 [1.2] mg/L) and fibrinogen (379 [88] vs 356 [80] vs 345 [73] mg/dL) levels. Persistent asthmatics had the lowest unadjusted CVD-free survival rate of 84.1%, 95% confidence interval (78.9–90.3%) compared with intermittent asthmatics 91.1% (88.5–93.8%) and non-asthmatics 90.2% (89.4–91%). Persistent asthmatics had greater risk of CVD events than non-asthmatics (HR 1.6 [95% 1.01–2.5, p=0.040]), even after adjustment for age, sex, race, CVD risk factors, and anti-hypertensive and lipid medication use. Conclusions In this large multi-ethnic cohort, persistent asthmatics had a higher CVD event rate than non-asthmatics.

Asthma Associates With Human Abdominal Aortic Aneurysm and Rupture

“…This potential limitation led us to define asthma as those patients who had ROPD and recorded the use of bronchodilators, as reported recently in an atherosclerosis risk-assessment study. 26 Higher odds ratios of aortic rupture from AAA patients with hospital-diagnosed asthma were identified than those from AAA patients who received anti-asthmatic medication (Figure 1 and Table 2), suggesting that we have underestimated the risk of asthma on AAA by defining asthma as the recorded use of bronchodilators and anti-asthmatic drugs (beta-2-adrenergic receptor agonists, anti-cholinergic medications, inhaled glucocorticoids, and xanthines). The strengths of this study include the use of two relatively large population-based cohorts, which both support the association of ROPD with the risk of having an AAA and rupture of an existing AAA.…”

“…29 Recent data from the Multi-Ethnic Study of Atherosclerosis show that asthmatic patients who use inhaled corticosteroids, leukotriene inhibitors, or oral corticosteroids have significantly higher plasma C-reactive protein and fibrinogen concentrations, lower unadjusted cardiovascular disease (CVD)-free survival rate and higher CVD risk than asthmatic patients who do not use these medications or those without asthma. 26 Although atherosclerosis may not underlie all AAA, atherosclerosis usually accompanies aneurysmal dilation, 30 and constitutes a long-recognized risk factor of AAA. 31 We recently demonstrated directly that the development of allergic airway inflammation in mice doubled the size of experimental AAA, regardless of whether allergic airway inflammation began before, after, or during AAA formation.…”

Evaluation of Arterial Stiffness in Patients with Bronchial Asthma and Co-Existent Chronic Obstructive Pulmonary Disease

“…In patients with persistent asthma, the levels of C-reactive protein and fibrinogen were significantly higher as well that indicated the relation between the inflammatory processes and cardiovascular diseases in asthma [20,21]. These preliminary studies have pointed out increased arterial stiffness in patients with asthma as compared to healthy individuals [22,23].…”

Atherosclerotic Plaque Rupture

“…20,21 Chronic inflammatory diseases such as asthma are also associated with an increased cardiovascular event rate. 20 It is, therefore, no surprise that the inflammation marker C-reactive protein (CRP) has been extensively investigated as a biomarker for cardiovascular risk.…”

“…20,21 Chronic inflammatory diseases such as asthma are also associated with an increased cardiovascular event rate. 20 It is, therefore, no surprise that the inflammation marker C-reactive protein (CRP) has been extensively investigated as a biomarker for cardiovascular risk. Indeed, large-scale epidemiological data have demonstrated that the inflammatory marker CRP predicts cardiovascular events, especially in intermediate-risk patients, and, most importantly, retains its risk-prediction value under therapy.…”