MESA Analysis Uncovers Link Between Persistent Asthma and Cardiovascular Disease

November 16, 2014

CHICAGO, IL — An analysis from the Multi-Ethnic Study of Atherosclerosis (MESA) suggests there may be an association between persistent asthma and the risk of cardiovascular disease[1].

In a new study presented this week at the American Heart Association (AHA) 2014 Scientific Sessions, investigators report that patients with persistent asthma had a 60% higher risk of cardiovascular events, including MI, resuscitated cardiac arrest, angina, stroke, and cardiovascular/stroke death, over a 9-year follow-up period when compared with individuals without asthma.

In addition, the investigators also observed significantly elevated age-adjusted levels of C-reactive protein (CRP) and fibrinogen among patients with persistent asthma, a finding that suggests a link between the inflammatory processes in asthma and cardiovascular disease. Still, investigators say the reason for the heightened risk of cardiovascular disease among asthmatics is not known.

"The most important clinical take-home message from our research is that patients with asthma and their physicians should be aware that they are increased risk for heart and vascular disease," senior investigator Dr James Stein (University of Wisconsin, Madison) told heartwire . "Although we are not certain of the mechanism, it behooves them to pay close attention to their traditional risk factors such as blood pressure, cholesterol, smoking, and obesity."

The analysis was led by Dr Matthew Tattersall (University of Wisconsin, Madison) and included 6792 individuals participating in MESA. The study included a mix of patients, including white, Chinese, African-American, and Hispanic individuals. Nearly half of the patients were male, and the average age was 62 years. Of the cohort, 156 had persistent asthma, defined as the need for regular controller medications such as inhaled corticosteroids, oral corticosteroids, and leukotriene inhibitors; 511 had intermittent asthma (those diagnosed with asthma but not taking controller medication); and 6125 were without asthma.

Among patients with persistent asthma, 84.1% were alive and free from cardiovascular disease at 10 years compared with 91.1% of patients with intermittent asthma and 90.2% of patients without asthma. After adjustment for age, race, and gender, as well as other potential confounding variables such as cholesterol levels, blood pressure, smoking status, diabetes, medication use, body-mass index, family history, and income, individuals with persistent asthma had a 59% increased risk of cardiovascular-disease events compared with those without asthma. There was no association between those with intermittent asthma and cardiovascular outcomes.

As noted, fibrinogen, CRP, and interleukin-6 levels, all markers of inflammation, were significantly elevated among those with persistent asthma compared with patients with intermittent asthma and no asthma.

To heartwire , Tattersall said it is unknown if asthma, which is the result of inflammation in the bronchioles and airway narrowing, resulted in more systemic inflammation throughout the vasculature. While the present study shows higher levels of inflammation in patients with persistent asthma, it is not known whether these patients simply have higher levels of inflammation than nonasthmatics or whether such inflammation, rather than some unmeasured variable, contributes to cardiovascular disease.

To date, there have been previous analyses examining the association between asthma and cardiovascular disease, including a Kaiser Permanente claims study. An analysis of patients in the Atherosclerosis Risk in Communities (ARIC) study showed that patients with current asthma had a significantly increased risk of stroke. Tattersall said that asthma affects 25 million Americans and disproportionately affects ethnic minorities, making the MESA cohort an excellent cohort to study for this possible association.

Like Stein, Tattersall said the most important thing clinicians and patients can do is focus on primary prevention. Despite the 60% higher risk of cardiovascular disease among asthmatic patients, other modifiable risk factors, such as smoking, high blood pressure, and elevated cholesterol levels, are bigger contributors to cardiovascular events, said Tattersall.

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