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Granda P, Villamañán E, Laorden D, Carpio C, Collada V, Domínguez-Ortega J, de las Vecillas L, Romero-Ribate D, Chaparro-Díaz OF, Lázaro Miguel-Sin T, Alloca-Álvarez DJ, Correa-Borit JM, Losantos I, Mir-Ihara P, Narváez-Fernández EJ, Quirce S, Álvarez-Sala R. Cardiovascular Events in Patients with Severe Asthma-A Retrospective Study of Two Cohorts: Asthma Type T2 Treated with Biologics and Non-Type T2. J Clin Med 2024; 13:4299. [PMID: 39124568 PMCID: PMC11313306 DOI: 10.3390/jcm13154299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 08/12/2024] Open
Abstract
Background: The prevalence of cardiovascular events (CVEs) in patients with asthma varies amongst studies, with little evidence as to their prevalence in patients treated with monoclonal antibodies (mAbs). In this retrospective, observational study, we aimed to evaluate the prevalence of CVEs in patients with T2 and non-T2 asthma and to identify risk factors associated with CVEs. Methods: A total of 206 patients with severe asthma were included. Demographic variables, respiratory comorbidities and cardiovascular risk factors were collected, along with respiratory function, laboratory parameters and respiratory pharmacotherapy, including treatment with mAbs. Results: A total of 10.7% of the patients had any CVE from the date of asthma diagnosis, with a higher risk in those patients with chronic obstructive pulmonary disease (odds ratio [OR] = 5.36, 95% CI 1.76-16.31; p = 0.003), arterial hypertension (OR = 2.71, 95% CI 1.13-6.55; p = 0.026) and dyslipidaemia (OR = 9.34, 95% CI 3.57-24.44; p < 0.001). No association between mAb treatment and a CVE or between time of mAb treatment and the event was found. No significant differences were observed between the T2 and non-T2 cohort. After a multivariate analysis, dyslipidaemia was identified as an independent risk factor (OR = 13.33, 95% CI 4.49-39.58; p < 0.001), whereas regular use of inhaled corticosteroids was associated with a reduced risk of a CVE (OR = 0.103, 95% CI 0.021-0.499; p = 0.005). Further research is needed to fully understand the relationship between severe asthma and CVEs. Conclusions: This study suggests that patients with severe asthma experience a higher percentage of CVEs compared with the general population.
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Affiliation(s)
- Paula Granda
- Pharmacy Department, Gómez Ulla Military Hospital, 28047 Madrid, Spain
| | - Elena Villamañán
- Pharmacy Department, La Paz University Hospital, IdiPAZ, 28029 Madrid, Spain; (E.V.); (V.C.)
- Medicine Department, Autonomous University of Madrid, 28049 Madrid, Spain; (C.C.); (R.Á.-S.)
| | - Daniel Laorden
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Carlos Carpio
- Medicine Department, Autonomous University of Madrid, 28049 Madrid, Spain; (C.C.); (R.Á.-S.)
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Victoria Collada
- Pharmacy Department, La Paz University Hospital, IdiPAZ, 28029 Madrid, Spain; (E.V.); (V.C.)
| | - Javier Domínguez-Ortega
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - Leticia de las Vecillas
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - David Romero-Ribate
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Omar Fabián Chaparro-Díaz
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Teresa Lázaro Miguel-Sin
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Daniela Jose Alloca-Álvarez
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Jorge Mauricio Correa-Borit
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - Itsaso Losantos
- Biostatistics Department, La Paz University Hospital, 28046 Madrid, Spain;
| | - Patricia Mir-Ihara
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - Emilio José Narváez-Fernández
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - Santiago Quirce
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - Rodolfo Álvarez-Sala
- Medicine Department, Autonomous University of Madrid, 28049 Madrid, Spain; (C.C.); (R.Á.-S.)
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
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Choi HG, Kwon MJ, Kim JH, Kim SY, Kim JH, Park JY, Hwang YI, Jang SH. Association between asthma and cardiovascular diseases: A longitudinal follow-up study using a national health screening cohort. World Allergy Organ J 2024; 17:100907. [PMID: 38873616 PMCID: PMC11170141 DOI: 10.1016/j.waojou.2024.100907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/14/2024] [Accepted: 04/16/2024] [Indexed: 06/15/2024] Open
Abstract
Background Asthma has been suggested to be a risk factor for cardiovascular diseases (CVDs), although the evidence supporting this relationship is inconclusive. This study aimed to explore the long-term associations between asthma and asthma exacerbations with the occurrence of cardiovascular diseases (CVDs) such as ischemic heart disease (IHD), heart failure (HF), and cerebral stroke, utilizing data from a nationwide cohort. Materials and methods This study utilized data from the Korean National Health Insurance Service-Health Screening Cohort database (2002-2015), including information on 111,316 asthma patients and an equal number of 1:1 matched control participants. A propensity score overlap-weighted Cox proportional hazards regression model was used to analyze the overlap-weighted hazard ratios (HRs) of asthma and exacerbated asthma for cardiovascular diseases (CVDs) within this cohort. Results During the follow-up period, the incidence rate (IR) of IHD per 1000 person-years (PYs) was 7.82 in patients with asthma and 5.79 in controls. The IR of HF was 2.53 in asthmatic patients and 1.36 in controls. After adjustment for covariates, asthmatic patients exhibited 1.27-fold and 1.56-fold higher HRs for IHD (95% confidence interval (CI) = 1.23-1.37, P < 0.001) and HF (95% CI = 1.36-1.63, P < 0.001) than the controls, respectively. In addition, there was an increased HR for IHD and HF in the asthma exacerbation group compared with the nonexacerbated asthma group (adjusted HR, 1.29, 95% CI = 1.24-1.34, P < 0.001 for IHD and aHR 1.68, 95% CI = 1.58-1.79, P < 0.001 for HF). However, the occurrence of stroke was decreased in asthmatic patients compared with controls (aHR = 0.96, 95% CI = 0.93-0.99, P = 0.008). Conclusions Adults with asthma are more likely to develop CVDs. Additionally, severe asthma exacerbations are significantly associated with an increased occurrence of CVDs.
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Affiliation(s)
- Hyo Geun Choi
- Suseo Seoul E.N.T. Clinic and MD Analytics, Seoul, South Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Ji Young Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Yong Il Hwang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Seung Hun Jang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
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Tattersall MC, Jarjour NN, Busse PJ. Systemic Inflammation in Asthma: What Are the Risks and Impacts Outside the Airway? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:849-862. [PMID: 38355013 PMCID: PMC11219096 DOI: 10.1016/j.jaip.2024.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024]
Abstract
Airway inflammation in asthma has been well recognized for several decades, with general agreement on its role in asthma pathogenesis, symptoms, propensity toward exacerbation, and decline in lung function. This has led to universal recommendation in asthma management guidelines to incorporate the use of inhaled corticosteroid as an anti-inflammatory therapy for all patients with persistent asthma symptoms. However, there has been limited attention paid to the presence and potential impact of systemic inflammation in asthma. Accumulating evidence from epidemiological observations and cohort studies points to a host of downstream organ dysfunction in asthma especially among patients with longstanding or more severe disease, frequent exacerbations, and underlying risk factors for organ dysfunction. Most studies to date have focused on cognitive impairment, depression/anxiety, metabolic syndrome, and cardiovascular abnormalities. In this review, we summarize some of the evidence demonstrating these abnormalities and highlight the proposed mechanisms and potential benefits of treatment in limiting these extrapulmonary abnormalities in patients with asthma. The goal of this commentary is to raise awareness of the importance of recognizing potential extrapulmonary conditions associated with systemic inflammation of asthma. This area of treatment of patients with asthma is a large unmet need.
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Affiliation(s)
- Matthew C Tattersall
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Nizar N Jarjour
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Paula J Busse
- Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai School of Medicine, New York, NY
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Warm K, Hedman L, Stridsman C, Lindberg A, Rönmark E, Backman H. Age-related differences in associations between uncontrolled asthma, comorbidities and biomarkers in adult-onset asthma. J Asthma 2023; 60:2224-2232. [PMID: 37405375 DOI: 10.1080/02770903.2023.2231078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/25/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Adult-onset asthma is a recognized but heterogeneous phenotype and has been described to associate with poor asthma control. Knowledge about associations between clinical characteristics including comorbidities and control of adult-onset asthma is limited, especially in older populations. We aimed to study how clinical biomarkers and comorbidities are associated with uncontrolled asthma among middle-aged and older individuals with adult-onset asthma. METHODS Clinical examinations including structured interview, asthma control test (ACT), spirometry, skin prick test (SPT), blood sampling, and measurement of exhaled fractional nitric oxide (FeNO) was performed in a population-based adult-onset asthma cohort in 2019-2020 (n = 227, 66.5% female). Analyses were performed among all included, and separately in middle-aged (37-64 years, n = 120) and older (≥65 years, n = 107) participants. RESULTS In bivariate analysis, uncontrolled asthma (ACT ≤ 19) was significantly associated with a blood neutrophil count ≥5/µl, BMI ≥30, and several comorbidities. In multivariable regression analysis, uncontrolled asthma was associated with neutrophils ≥5/µl (OR 2.35; 95% CI 1.11-4.99). In age-stratified analysis, BMI ≥30 (OR 3.04; 1.24-7.50), eosinophils ≥0.3/µl (OR 3.17; 1.20-8.37), neutrophils ≥5/µl (OR 4.39; 1.53-12.62) and allergic rhinitis (OR 5.10; 1.59-16.30) were associated with uncontrolled asthma among the middle-aged. Among the older adults, uncontrolled asthma was only associated with comorbidities: chronic rhinitis (OR 4.08; 1.62-10.31), ischemic heart disease (OR 3.59; 1.17-10.98), malignancy (OR 3.10; 1.10-8.73), and depression/anxiety (OR 16.31; 1.82-146.05). CONCLUSIONS In adult-onset asthma, comorbidities were strongly associated with uncontrolled asthma among older adults, while clinical biomarkers including eosinophils and neutrophils in blood were associated with uncontrolled asthma among middle-aged.
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Affiliation(s)
- Katja Warm
- The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Caroline Stridsman
- The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Eva Rönmark
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Helena Backman
- Section of Sustainable Health, The OLIN Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Zhao Q, Liu R, Chen H, Yang X, Dong J, Bai M, Lu Y, Leng Y. Transcriptome-wide association study reveals novel susceptibility genes for coronary atherosclerosis. Front Cardiovasc Med 2023; 10:1149113. [PMID: 37351287 PMCID: PMC10282549 DOI: 10.3389/fcvm.2023.1149113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023] Open
Abstract
Background Genetic risk factors substantially contributed to the development of coronary atherosclerosis. Genome-wide association study (GWAS) has identified many risk loci for coronary atherosclerosis, but the translation of these loci into therapeutic targets is limited for their location in non-coding regions. Here, we aimed to screen the potential coronary atherosclerosis pathogenic genes expressed though TWAS (transcriptome wide association study) and explore the underlying mechanism association. Methods Four TWAS approaches (PrediXcan, JTI, UTMOST, and FUSION) were used to screen genes associated with coronary atherosclerosis. Enrichment analysis of TWAS-identified genes was applied through the Metascape website. The summary-data-based Mendelian randomization (SMR) analysis was conducted to provide the evidence of causal relationship between the candidate genes and coronary atherosclerosis. At last, the cell type-specific expression of the intersection genes was examined by using human coronary artery single-cell RNA-seq, interrogating the immune microenvironment of human coronary atherosclerotic plaque at different stages of maturity. Results We identified 19 genes by at least three approaches and 1 gene (NBEAL1) by four approaches. Enrichment analysis enriching the genes identified at least by two TWAS approaches, suggesting that these genes were markedly enriched in asthma and leukocyte mediated immunity reaction. Further, the summary-data-based Mendelian randomization (SMR) analysis provided the evidence of causal relationship between NBEAL1 gene and coronary atherosclerosis, confirming the protecting effects of NBEAL1 gene and coronary atherosclerosis. At last, the single cell cluster analysis demonstrated that NBEAL1 gene has differential expressions in macrophages, plasma cells and endothelial cells. Conclusion Our study identified the novel genes associated with coronary atherosclerosis and suggested the potential biological function for these genes, providing insightful guidance for further biological investigation and therapeutic approaches development in atherosclerosis-related diseases.
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Affiliation(s)
- Qiuping Zhao
- Heart Center of Henan Provincial People’s Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Rongmei Liu
- Heart Center of Henan Provincial People’s Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Hui Chen
- Heart Center of Henan Provincial People’s Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Xiaomo Yang
- Heart Center of Henan Provincial People’s Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Jiajia Dong
- Heart Center of Henan Provincial People’s Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Minfu Bai
- Heart Center of Henan Provincial People’s Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Yao Lu
- School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Yiming Leng
- Clinical Research Center, The Third Xiangya Hospital, Central South University, Changsha, China
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
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Honkamäki J, Ilmarinen P, Hisinger-Mölkänen H, Tuomisto LE, Andersén H, Huhtala H, Sovijärvi A, Lindqvist A, Backman H, Nwaru BI, Rönmark E, Lehtimäki L, Pallasaho P, Piirilä P, Kankaanranta H. Nonrespiratory Diseases in Adults Without and With Asthma by Age at Asthma Diagnosis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:555-563.e4. [PMID: 36441098 DOI: 10.1016/j.jaip.2022.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Chronic nonrespiratory diseases are seemingly more prevalent in subjects with than without asthma, and asthma seems to differentiate by age of onset. However, studies with comparison of nonrespiratory diseases in subjects with and without asthma, considering asthma age of onset, are scarce. OBJECTIVE To compare the quantity and type of chronic nonrespiratory diseases in adults with and without asthma considering age at asthma diagnosis. METHODS In 2016, a FinEsS questionnaire was sent to 16,000 20- to 69-year-old adults randomly selected in Helsinki and Western Finland populations. Physician-diagnosed asthma was categorized to early (0-11), intermediate (12-39), and late-diagnosed (40-69 years). RESULTS A total of 8199 (51.5%) responded, and 842 (10.3%) reported asthma and age at diagnosis. In age and sex-adjusted binary logistic regression model, the most represented nonrespiratory disease was treated gastroesophageal reflux disease in early-diagnosed (odds ratio, 1.93; 95% CI, 1.17-3.19; P = .011) and osteoporosis in both intermediate-diagnosed (odds ratio, 3.45; 95% CI, 2.01-5.91; P < .001) and late-diagnosed asthma (odds ratio, 2.91; 95% CI, 1.77-4.79; P < .001), compared with subjects without asthma. In addition, gastroesophageal reflux disease, depression, sleep apnea, painful condition, and obesity were significantly more common in intermediate- and late-diagnosed asthma compared with without asthma, and similarly anxiety or panic disorder in intermediate-diagnosed and hypertension, severe cardiovascular disease, arrhythmia, and diabetes in late-diagnosed asthma. In age-adjusted analyses, having 3 or more nonrespiratory diseases was more common in intermediate (12.1%) and late-diagnosed asthma (36.2%) versus without asthma (10.4%) (both P < .001). CONCLUSIONS Nonrespiratory diseases were more common in adults with asthma than in adults without asthma. The type of nonrespiratory diseases differed, and their frequency increased by increasing age at asthma diagnosis.
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Affiliation(s)
- Jasmin Honkamäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pinja Ilmarinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | | | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Heidi Andersén
- Karolinska University Hospital, Thoracic Oncology Unit, Tema Cancer, Stockholm, Sweden
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Anssi Sovijärvi
- Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Ari Lindqvist
- Research Unit of Pulmonary Diseases, Helsinki University Hospital, University of Helsinki and Clinical Research Institute HUCH Ltd, Helsinki, Finland
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden
| | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/the OLIN Unit, Umeå University, Umeå, Sweden
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Allergy Centre, Tampere University Hospital, Tampere, Finland
| | | | - Päivi Piirilä
- Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Tattersall MC. Asthma as a Systemic Disease: Cardiovascular Effects Associated with Asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:77-100. [PMID: 37464117 DOI: 10.1007/978-3-031-32259-4_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Asthma and cardiovascular disease (CVD) pose significant public health burdens. Airway inflammation is central to asthma pathophysiology and systemic inflammation, which occurs in asthma, is central to CVD pathophysiology. Numerous robust epidemiological studies have demonstrated deleterious systemic cardiovascular effects associated with the asthma syndrome. The cardiovascular effects associated with asthma include arterial injury, atherosclerotic CVD events, atrial fibrillation, and hypertension. Asthma is a heterogeneous disease, however, and the risk of CVD is not homogeneous across the various clinical phenotypes and molecular endotypes, highlighting prior inconsistent associations of asthma and its subtypes with various forms of CVD. The mechanistic underpinnings of the increased CVD risk in asthma remain multifactorial and undefined. Collectively, this supports the need for a precision approach in the identification of individuals with asthma who remain at elevated risk of development of cardiovascular diseases to guide both diagnostic and preventive interventions to decrease CVD risk among individuals living with asthma.
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Tattersall MC, Dasiewicz AS, McClelland RL, Jarjour NN, Korcarz CE, Mitchell CC, Esnault S, Szklo M, Stein JH. Persistent Asthma Is Associated With Carotid Plaque in MESA. J Am Heart Assoc 2022; 11:e026644. [PMID: 36416156 PMCID: PMC9851438 DOI: 10.1161/jaha.122.026644] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022]
Abstract
Background Asthma and atherosclerotic cardiovascular disease share an underlying inflammatory pathophysiology. We hypothesized that persistent asthma is associated with carotid plaque burden, a strong predictor of atherosclerotic cardiovascular disease events. Methods and Results The MESA (Multi-Ethnic Study of Atherosclerosis) enrolled adults free of known atherosclerotic cardiovascular disease at baseline. Subtype of asthma was determined at examination 1. Persistent asthma was defined as asthma requiring use of controller medications, and intermittent asthma was defined as asthma without controller medications. B-mode carotid ultrasound was performed to detect carotid plaques (total plaque score [TPS], range 0-12). Multivariable regression modeling with robust variances evaluated the association of asthma subtype and carotid plaque burden. The 5029 participants were a mean (SD) age of 61.6 (10.0) years (53% were women, 26% were Black individuals, 23% were Hispanic individuals, and 12% were Chinese individuals). Carotid plaque was present in 50.5% of participants without asthma (TPS, 1.29 [1.80]), 49.5% of participants with intermittent asthma (TPS, 1.25 [1.76]), and 67% of participants with persistent asthma (TPS, 2.08 [2.35]) (P≤0.003). Participants with persistent asthma had higher interleukin-6 (1.89 [1.61] pg/mL) than participants without asthma (1.52 [1.21] pg/mL; P=0.02). In fully adjusted models, persistent asthma was associated with carotid plaque presence (odds ratio, 1.83 [95% confidence interval, 1.21-2.76]; P<0.001) and TPS (β=0.66; P<0.01), without attenuation after adjustment for baseline interleukin-6 (P=0.02) or CRP (C-reactive protein) (P=0.01). Conclusions Participants with persistent asthma had higher carotid plaque burden and higher levels of inflammatory biomarkers, compared with participants without asthma. Adjustment for baseline inflammatory biomarkers did not attenuate the association between carotid plaque and asthma subtype, highlighting the increased atherosclerotic cardiovascular disease risk among those with persistent asthma may be multifactorial.
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Affiliation(s)
- Matthew C. Tattersall
- Department of Medicine, Division of Cardiovascular MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
| | - Alison S. Dasiewicz
- Centre for Global Child HealthHospital for Sick ChildrenTorontoOntarioCanada
| | | | - Nizar N. Jarjour
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care MedicineBaltimoreMD
| | - Claudia E. Korcarz
- Department of Medicine, Division of Cardiovascular MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
| | - Carol C. Mitchell
- Department of Medicine, Division of Cardiovascular MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
| | - Stephane Esnault
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care MedicineBaltimoreMD
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - James H. Stein
- Department of Medicine, Division of Cardiovascular MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
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Smirnova MI, Kurekhyan AS, Gorbunov VM, Andreeva GF, Koshelyaevskaya YN, Deev АD. Prospective follow-up of hypertensive patients with concomitant chronic respiratory diseases in routine practice. Part I. Characterization of adverse events. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The most common cardiovascular disease (CVD) and risk factor for the main causes of death is hypertension (HTN), the prevalence of which in Russia is 44%. The combination of HTN and chronic respiratory diseases (CRDs) can lead to mutual influence and worsen the prognosis.Aim. To study long-term outcomes in HTN patients with CRDs under outpatient monitoring in primary health care.Material and methods. This prospective observational study of hypertensive outpatients (n=156, age, 63,4±8,8 years, men, 27,6%) was carried out, of which 49 had asthma, 20 — chronic obstructive pulmonary disease (n=69; group with CRD). The composite primary endpoint included death, myocardial infarction, cerebral stroke, transient ischemic attack, arterial revascularization, angina pectoris, peripheral arterial disease (>50% stenosis), heart failure, atrial fibrillation, and ventricular premature beats >30 h. There were following secondary endpoints: hypertensive crisis, hospitalization, emergency call and temporary disability due to cardiovascular diseases, asthma, chronic obstructive pulmonary disease, pneumonia, chronic respiratory failure. In addition, the following tertiary endpoints were analyzed: increased blood pressure (BP) without a hypertensive crisis, which required correction of HTN therapy, deterioration in CRD course (an increase in the ACQ-5 or CAT total score without exacerbation), acute bronchitis, other acute diseases and exacerbations of chronic ones, which required hospitalizations, new clinically significant chronic diseases not included in the primary and secondary endpoints.Results. The follow-up period was 29±8 months. The groups did not differ in relation to prevalence of primary endpoints. The frequency of secondary and tertiary endpoints was higher in the CRD group due to "respiratory" events and episodes of BP destabilization requiring correction of HTN therapy (p<0,01). In HTN patients with CRDs, cumulative survival was lower, and the cumulative risk of adverse events was higher.Conclusion. Larger studies are needed in this area, as well as an analysis of the factors associated with adverse outcomes in hypertensive patients, including BP characteristics and accounting for CRDs, in order to improve preventive approaches.
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Affiliation(s)
- M. I. Smirnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. S. Kurekhyan
- National Medical Research Center for Therapy and Preventive Medicine
| | - V. M. Gorbunov
- National Medical Research Center for Therapy and Preventive Medicine
| | - G. F. Andreeva
- National Medical Research Center for Therapy and Preventive Medicine
| | | | - А. D. Deev
- National Medical Research Center for Therapy and Preventive Medicine
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10
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Bronchial Asthma as a Cardiovascular Risk Factor: A Prospective Observational Study. Biomedicines 2022; 10:biomedicines10102614. [PMID: 36289876 PMCID: PMC9599703 DOI: 10.3390/biomedicines10102614] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Asthma as a chronic inflammatory disorder has been suggested as a risk factor for endothelial dysfunction (ED), but studies on the association between asthma and cardiovascular disease (CVD) risk are limited. Background: We assessed associations of ED with the severity of asthma, eosinophilic inflammation, lung function, and asthma control. Methods: 52 young asthmatics (median age of 25.22 years) and 45 healthy individuals were included. Demographic, clinical, and laboratory findings were recorded. We evaluated microvascular responsiveness by recording the reactive hyperemia index (RHI) indicating post-occlusive peripheral endothelium-dependent changes in vascular tone using the Itamar Medical EndoPAT2000. VCAM-1, ADMA, high-sensitive CRP (hsCRP), and E-selectin were measured. Results: Asthmatics had considerably lower RHI values (p < 0.001) with a dynamic decreasing trend by asthma severity and higher hsCRP levels (p < 0.001). A substantial increase in hsCRP and E-selectin with asthma severity (p < 0.05) was also observed. We confirmed a higher body mass index (BMI) in asthmatics (p < 0.001), especially in women and in severe asthma. Conclusions: We demonstrated the progression of CVD in asthmatics and the association of the ongoing deterioration of ED with the inflammatory severity, suggesting that the increased risk of CVD in young asthmatics is dependent on disease severity. The underlying mechanisms of risk factors for CVD and disease control require further study.
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11
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Fang ZH, Li ZF, An ZY, Huang SC, Hao MD, Zhang WX. Meta-Analysis of the Association Between Asthma and the Risk of Stroke. Front Neurol 2022; 13:900438. [PMID: 35812117 PMCID: PMC9263265 DOI: 10.3389/fneur.2022.900438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionAsthma and stroke share many risk factors. Previous meta-analysis has indicated that asthma is associated with an increased risk of stroke. However, this study were limited by the small number of articles included and the lack of subgroup analyses of different stroke types and different populations. This meta-analysis aimed to synthesize evidence systematically to investigate the impact of asthma on stroke.MethodsWe searched Medline (via PubMed), Web of Science and EMBASE databases and manually identified eligible studies (inception dates to December 25, 2021) that analyzed the association between asthma and stroke. We conducted quality assessment to evaluate the risk of bias of studies and sensitivity analyses to test the robustness of results.ResultsWe included 8 cohort studies and 10 cross-sectional studies comprised 3,011,016 participants. We found patients with asthma had a higher risk of stroke than patients without asthma [relative risk (RR): 1.34, 95% confidence interval (CI): 1.21–1.47]. Moreover, asthma significantly increased the risk of ischemic stroke (RR: 1.25, 95% CI: 1.06–1.47) without increasing the risk of hemorrhagic stroke (RR: 1.08, 95% CI: 0.87–1.34). Asthma increased the risk of stroke in both men (RR: 1.20, 95% CI: 1.10–1.32) and women (RR: 1.29, 95% CI: 1.12–1.48) with no significant difference between the sexes. We also found that patients with inactive asthma, child-onset asthma, or no smoking history did not have an increased risk of stroke.ConclusionsThese results supported the finding that asthma could significantly increase the risk of stroke, but this impact was not consistent in different populations.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=290745, identifier: CRD42021290745.
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Affiliation(s)
- Zheng-Hua Fang
- The First People's Hospital of Jiande, Hangzhou, China
- *Correspondence: Zheng-Hua Fang
| | - Zhi-Fei Li
- Aerospace Center Hospital, Beijing, China
| | - Zhuo-Yu An
- Peking University People's Hospital, Beijing, China
| | | | | | - Wei-Xing Zhang
- Department of Respiratory Medicine, The First People's Hospital of Jiande, Hangzhou, China
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12
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Bazan-Socha S, Wójcik K, Olchawa M, Sarna T, Pięta J, Jakieła B, Soja J, Okoń K, Zarychta J, Zaręba L, Stojak M, Potaczek DP, Bazan JG, Celińska-Lowenhoff M. Increased Oxidative Stress in Asthma-Relation to Inflammatory Blood and Lung Biomarkers and Airway Remodeling Indices. Biomedicines 2022; 10:1499. [PMID: 35884804 PMCID: PMC9312921 DOI: 10.3390/biomedicines10071499] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
Airway inflammation in asthma is related to increased reactive oxygen species generation, potentially leading to tissue injury and subsequent airway remodeling. We evaluated oxidative stress in peripheral blood from asthmatic subjects (n = 74) and matched controls (n = 65), using recently developed real-time monitoring of the protein hydroperoxide (HP) formation by the coumarin boronic acid (CBA) assay. We also investigated the relation of the systemic oxidative stress response in asthma to disease severity, lung function, airway remodeling indices (lung computed tomography and histology), and blood and bronchoalveolar lavage fluid (BAL) inflammatory biomarkers. We documented enhanced systemic oxidative stress in asthma, reflected by 35% faster and 58% higher cumulative fluorescent product generation in the CBA assay (p < 0.001 for both). The dynamics of HP generation correlated inversely with lung function but not with asthma severity or histological measures of airway remodeling. HP generation was associated positively with inflammatory indices in the blood (e.g., C-reactive protein) and BAL (e.g., interleukin [IL]-6, IL-12p70, and neutrophil count). Bronchial obstruction, thicker airway walls, increased BAL IL-6, and citrullinated histone 3 in systemic circulation independently determined increased HP formation. In conclusion, a real-time CBA assay showed increased systemic HP generation in asthma. In addition, it was associated with inflammatory biomarkers, suggesting that proper disease control can also lead to a decrease in oxidative stress.
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Affiliation(s)
- Stanisława Bazan-Socha
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Skawinska 8, 31-066 Krakow, Poland; (K.W.); (B.J.); (J.S.); (J.Z.); (M.C.-L.)
| | - Krzysztof Wójcik
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Skawinska 8, 31-066 Krakow, Poland; (K.W.); (B.J.); (J.S.); (J.Z.); (M.C.-L.)
| | - Magdalena Olchawa
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Gronostajowa 7, 30-387 Krakow, Poland; (M.O.); (T.S.)
| | - Tadeusz Sarna
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Gronostajowa 7, 30-387 Krakow, Poland; (M.O.); (T.S.)
| | - Jakub Pięta
- Institute of Applied Radiation Chemistry, Faculty of Chemistry, Lodz University of Technology, Zeromskiego 116, 90-924 Lodz, Poland;
| | - Bogdan Jakieła
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Skawinska 8, 31-066 Krakow, Poland; (K.W.); (B.J.); (J.S.); (J.Z.); (M.C.-L.)
| | - Jerzy Soja
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Skawinska 8, 31-066 Krakow, Poland; (K.W.); (B.J.); (J.S.); (J.Z.); (M.C.-L.)
| | - Krzysztof Okoń
- Department of Pathology, Faculty of Medicine, Jagiellonian University Medical College, Grzegorzecka 16, 31-531 Krakow, Poland;
| | - Jacek Zarychta
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Skawinska 8, 31-066 Krakow, Poland; (K.W.); (B.J.); (J.S.); (J.Z.); (M.C.-L.)
- Pulmonary Hospital, Gladkie 1, 34-500 Zakopane, Poland
| | - Lech Zaręba
- Institute of Computer Science, College of Natural Sciences, University of Rzeszow, Pigonia 1, 35-310 Rzeszow, Poland; (L.Z.); (J.G.B.)
| | - Michał Stojak
- Department of Plant Product Technology and Nutrition Hygiene, Faculty of Food Technology, University of Agriculture in Krakow, Balicka 122, 30-149 Krakow, Poland;
| | - Daniel P. Potaczek
- Translational Inflammation Research Division & Core Facility for Single Cell Multiomics, Philipps-University Marburg, 35043 Marburg, Germany;
| | - Jan G. Bazan
- Institute of Computer Science, College of Natural Sciences, University of Rzeszow, Pigonia 1, 35-310 Rzeszow, Poland; (L.Z.); (J.G.B.)
| | - Magdalena Celińska-Lowenhoff
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Skawinska 8, 31-066 Krakow, Poland; (K.W.); (B.J.); (J.S.); (J.Z.); (M.C.-L.)
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13
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Guo J, Zhang Y, Liu T, Levy BD, Libby P, Shi GP. Allergic asthma is a risk factor for human cardiovascular diseases. NATURE CARDIOVASCULAR RESEARCH 2022; 1:417-430. [PMID: 39195946 DOI: 10.1038/s44161-022-00067-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/08/2022] [Indexed: 08/29/2024]
Abstract
Asthma is an allergic airway disease in which type 2-mediated inflammation has a pathogenic role. Cardiovascular diseases (CVDs) are type 1-dominant inflammatory diseases in which type 2 cytokines often have a protective role. However, clinical studies demonstrate that allergic asthma and associated allergies are essential risk factors for CVD, including coronary heart diseases, aortic diseases, peripheral arterial diseases, pulmonary embolism, right ventricular dysfunction, atrial fibrillation, cardiac hypertrophy and even hypertension. Mast cells, eosinophils, inflammatory cytokines and immunoglobulin (Ig)E accumulate in asthmatic lungs and in the injured heart and vasculature of patients with CVD. Clinical studies show that many anti-asthmatic therapies affect the risk of CVD. As such, allergic asthma and CVD may share common pathogenic mechanisms. Preclinical investigations indicate that anti-asthmatic drugs have therapeutic potential in certain CVDs. In this Review, we discuss how asthma and allied allergic conditions may contribute to the prevalence, incidence and progression of CVD and vice versa.
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Affiliation(s)
- Junli Guo
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Key Laboratory of Tropical Cardiovascular Diseases Research of Hainan Province & Key Laboratory of Emergency and Trauma of Ministry of Education, the First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yuanyuan Zhang
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Key Laboratory of Tropical Cardiovascular Diseases Research of Hainan Province & Key Laboratory of Emergency and Trauma of Ministry of Education, the First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Tianxiao Liu
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Bruce D Levy
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Peter Libby
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Guo-Ping Shi
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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14
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Wee JH, Park MW, Min C, Byun SH, Park B, Choi HG. Association between asthma and cardiovascular disease. Eur J Clin Invest 2021; 51:e13396. [PMID: 32888313 DOI: 10.1111/eci.13396] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/25/2020] [Accepted: 08/29/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Epidemiological studies on the association between asthma and cardiovascular disease have reported conflicting results. This cross-sectional study evaluated the association between asthma and ischaemic heart disease (IHD)/stroke in Korean adults. MATERIALS AND METHODS Data from the Korean Genome and Epidemiology Study-Health Examinees were used. Among 173 209 participants, 3162 asthmatic and 159 408 control participants were selected. Histories of asthma, IHD and stroke were obtained. Participants were categorized according to their current status of asthma management: 'well-controlled', 'being treated', and 'not being treated'. Crude and adjusted (age, gender, body mass index, income, smoking, alcohol consumption, hypertension, diabetes, dyslipidaemia and nutritional intake) odds ratios (ORs) for IHD and stroke in asthmatic patients were analysed using a multiple logistic regression model. RESULTS Participants with asthma reported a significantly higher prevalence of IHD (6.0% vs 3.0%) and stroke (2.3% vs 1.4%) than those without asthma (P < .001). Asthmatic participants had a higher OR (1.46, 95% confidence interval [CI] = 1.251-1.71, P < .001) for IHD than those without asthma. The association between asthma and IHD was significant only in patients aged ≥53 years (men: adjusted OR = 1.31, 95% CI = 1.01-1.70, P = .046; women: adjusted OR = 1.64, 95% CI = 1.32-2.03, P < .001) according to age and sex and in the 'not being treated' asthma group (adjusted OR = 1.47, 95% CI = 1.14-1.91, P = .003) according to the asthma management status. Stroke was not significantly associated with asthma (adjusted OR = 1.17, 95% CI = 0.92-1.48, P = .203) in the adjusted model and all subgroup analyses. CONCLUSION Asthma was associated with IHD, mainly in older patients and untreated asthma patients, but not with stroke.
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Affiliation(s)
- Jee Hye Wee
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Min Woo Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Chanyang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea.,Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Soo Hwan Byun
- Department of Oral & Maxillofacial Surgery, Dentistry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Bumjung Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.,Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea
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15
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Baysal SS, Has M. Assessment of biventricular function with speckle tracking echocardiography in newly-diagnosed adult-onset asthma. J Asthma 2020; 59:306-314. [PMID: 33158387 DOI: 10.1080/02770903.2020.1847928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE There is limited number of studies on the effect of asthma disease on cardiac functions. The aim of this study was to investigate if there was any association between adult onset asthma and cardiac dysfunction. METHODS Total of 83 nonsmoking adult onset asthma patients aged between 18 and 65, and 83 control subjects with comparable age and sex distribution were included in the study.None of the subjects had any chronic cardiovascular or systemic diseases.Two-dimensional, M-mode and tissue Doppler examinations were performed. STE analysis was obtained using the QLAB software. Complete blood count and high-sensitive C-reactive protein (hsCRP) levels were measured. RESULTS There was no difference between two groups in terms of standard echocardiography and Doppler parameters. While tricuspid annular plane systolic excursion (TAPSE) was observed to be lower in asthmatics (24.9 ± 2.0 vs. 25.5 ± 2.1, p = 0.043), right ventricular myocardial performance index (RV MPI) was higher (0.36 ± 0.07 vs 0.32 ± 0.06, p˂0.001). There was no significant difference between the groups in terms of left ventricular STE parameters. Measurements of right ventricular global longitudinal strain (RVGLS) and right ventricular free wall strain (RVfree) were observed to be lower in the asthma group (-20.3 ± 2.9 vs -21.5 ± 2.9, p = 0.007; -24.0 ± 3.0 vs 25.1 ± 2.9, p = 0.009, respectively). CONCLUSION -We demonstrated that while adult onset mild-stage asthma patients have normal parameters in standard echocardiography, they have reduced right ventricular functions by STE.
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Affiliation(s)
- Sadettin Selçuk Baysal
- Cardiology Deparment, Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
| | - Mehmet Has
- Deparment of Allergy and Respiratory Diseases, Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
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16
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Pérez de Llano L, Rivas DD. Asthma Attacks and Cardiovascular Events: Earthquakes and Tsunamis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:195-196. [PMID: 31950902 DOI: 10.1016/j.jaip.2019.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 08/31/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Luis Pérez de Llano
- Department of Respiratory Medicine, Lucus Augusti University Hospital, EOXI Lugo, Cervo and Monforte, Spain.
| | - David Dacal Rivas
- Department of Respiratory Medicine, Lucus Augusti University Hospital, EOXI Lugo, Cervo and Monforte, Spain
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17
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Gurgone D, McShane L, McSharry C, Guzik TJ, Maffia P. Cytokines at the Interplay Between Asthma and Atherosclerosis? Front Pharmacol 2020; 11:166. [PMID: 32194407 PMCID: PMC7064545 DOI: 10.3389/fphar.2020.00166] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/07/2020] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular disease (CVD) is an important comorbidity in a number of chronic inflammatory diseases. However, evidence in highly prevalent respiratory disease such as asthma are still limited. Epidemiological and clinical data are not univocal in supporting the hypothesis that asthma and CVD are linked and the mechanisms of this relationship remain poorly defined. In this review, we explore the relationship between asthma and cardiovascular disease, with a specific focus on cytokine contribution to vascular dysfunction and atherosclerosis. This is important in the context of recent evidence linking broad inflammatory signaling to cardiovascular events. However inflammatory regulation in asthma is different to the one typically observed in atherosclerosis. We focus on the contribution of cytokine networks encompassing IL-4, IL-6, IL-9, IL-17A, IL-33 but also IFN-γ and TNF-α to vascular dysfunction in atherosclerosis. In doing so we highlight areas of unmet need and possible therapeutic implications.
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Affiliation(s)
- Danila Gurgone
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.,Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Lucy McShane
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.,Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Charles McSharry
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.,Department of Internal and Agricultural Medicine, Jagiellonian University College of Medicine, Kraków, Poland
| | - Pasquale Maffia
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.,Department of Pharmacy, University of Naples Federico II, Naples, Italy.,Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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18
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Tattersall MC, Dasiewicz AS, McClelland RL, Gepner AD, Kalscheur MM, Field ME, Heckbert SR, Hamdan MH, Stein JH. Persistent Asthma Is Associated With Increased Risk for Incident Atrial Fibrillation in the MESA. Circ Arrhythm Electrophysiol 2020; 13:e007685. [PMID: 32013555 DOI: 10.1161/circep.119.007685] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Asthma and atrial fibrillation (AF) share an underlying inflammatory pathophysiology. We hypothesized that persistent asthmatics are at higher risk for developing AF and that this association would be attenuated by adjustment for baseline markers of systemic inflammation. METHODS The MESA (Multi-Ethnic Study of Atherosclerosis) is a prospective longitudinal study of adults free of cardiovascular disease at baseline. Presence of asthma was determined at exam 1. Persistent asthma was defined as asthma requiring use of controller medications. Intermittent asthma was defined as asthma without use of controller medications. Participants were followed for a median of 12.9 (interquartile range, 10-13.6) years for incident AF. Multivariable Cox regression models were used to assess associations of asthma subtype and AF. RESULTS The 6615 participants were a mean (SD) 62.0 (10.2) years old (47% male, 27% black, 12% Chinese, and 22% Hispanic). AF incidence rates were 0.11 (95% CI, 0.01-0.12) events/10 person-years for nonasthmatics, 0.11 (95% CI, 0.08-0.14) events/10 person-years for intermittent asthmatics, and 0.19 (95% CI, 0.120.49) events/10 person-years for persistent asthmatics (log-rank P=0.008). In risk-factor adjusted models, persistent asthmatics had a greater risk of incident AF (hazard ratio, 1.49 [95% CI, 1.03-2.14], P=0.03). IL (Interleukin)-6 (hazard ratio, 1.26 [95% CI, 1.13-1.42]), TNF (tumor necrosis factor)-α receptor 1 (hazard ratio, 1.09 [95% CI, 1.08-1.11]) and D-dimer (hazard ratio, 1.10 [95% CI, 1.02-1.20]) predicted incident AF, but the relationship between asthma and incident AF was not attenuated by adjustment for any inflammation marker (IL-6, CRP [C-reactive protein], TNF-α R1, D-dimer, and fibrinogen). CONCLUSIONS In a large multiethnic cohort with nearly 13 years follow-up, persistent asthma was associated with increased risk for incident AF. This association was not attenuated by adjustment for baseline inflammatory biomarkers.
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Affiliation(s)
- Matthew C Tattersall
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., A.D.G., M.M.K., M.H.H., J.H.S.)
| | - Alison S Dasiewicz
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., A.D.G., M.M.K., M.H.H., J.H.S.).,Department of Biostatistics, University of Washington, Seattle (A.S.D., R.L.M.)
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle (A.S.D., R.L.M.)
| | - Adam D Gepner
- Division of Cardiovascular Medicine, Department of Medicine, William S. Middleton Memorial Veterans Hospital, Madison, WI (A.D.G., M.M.K.)
| | - Matthew M Kalscheur
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., A.D.G., M.M.K., M.H.H., J.H.S.).,Division of Cardiovascular Medicine, Department of Medicine, William S. Middleton Memorial Veterans Hospital, Madison, WI (A.D.G., M.M.K.)
| | - Michael E Field
- Department of Medicine, Medical University of South Carolina, Charleston (M.E.F.)
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington School of Public Health, Seattle (S.R.H.).,Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington and Group Health Research Institute, Group Health Cooperative, Seattle (S.R.H.)
| | - Mohamed H Hamdan
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., A.D.G., M.M.K., M.H.H., J.H.S.)
| | - James H Stein
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., A.D.G., M.M.K., M.H.H., J.H.S.)
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19
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Analysis of the Relationship between Adult Asthma and Stroke: A Longitudinal Follow-Up Study Using the Korean National Sample Cohort. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8919230. [PMID: 31317041 PMCID: PMC6601683 DOI: 10.1155/2019/8919230] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/10/2019] [Accepted: 05/27/2019] [Indexed: 11/22/2022]
Abstract
Several previous studies demonstrated the risk of stroke in asthma patients. The aim of this study was to evaluate the risk of hemorrhagic and ischemic stroke in asthma patients, independent of age, sex, income, region of residence, and past medical histories. The Korean Health Insurance Review and Assessment Service-National Sample Cohort from 2002 through 2013 was used. Overall, 111,364 asthma patients ≥ 20 years old were matched to 111,364 control participants for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia. Asthma was classified using ICD-10 codes (J45 and J46) and medication history. The admission histories were investigated for hemorrhagic stroke (I60-I62) and ischemic stroke (I63) using ICD-10 codes. The crude and adjusted (age, sex, income, region of residence, hypertension, diabetes, dyslipidemia, ischemic heart disease, and depression) hazard ratios (HRs) for hemorrhagic and ischemic stroke in asthma patients were analyzed using a Cox proportional hazards model. Subgroup analyses were conducted according to age and sex. Hemorrhagic and ischemic stroke were found in 0.7% (795/117,364) and 2.4% (922/117,364) of the asthma group and in 0.8% (922/117,364) and 2.6% (93,079/117,364) of the control group, respectively. The asthma group demonstrated adjusted HRs of 0.86 (95% confidence interval [CI] = 0.78-0.94, p = 0.002) for hemorrhagic stroke and 0.91 (95% CI = 0.86-0.95, p = 0.002) for ischemic stroke. None of the subgroups of asthma patients showed higher HRs for stroke. Asthma did not elevate the risk of either hemorrhagic or ischemic stroke.
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Ferreira MKM, Ferreira RDO, Castro MML, Magno MB, Almeida APCPSC, Fagundes NCF, Maia LC, Lima RR. Is there an association between asthma and periodontal disease among adults? Systematic review and meta-analysis. Life Sci 2019; 223:74-87. [PMID: 30849418 DOI: 10.1016/j.lfs.2019.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 12/28/2022]
Abstract
This systematic review and meta-analysis aimed to investigate a possible association between asthma and periodontal disease in adults. This study was conducted by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the searches were performed on the following databases: PubMed, Scopus, Web of Science, Cochrane, LILACS, OpenGrey e Google Scholar. In this systematic review, observational studies with adult humans, which evaluated patients with and without asthma, were selected to verify the association between both diseases. To qualitative analysis, Fowkes and Fulton guidelines was used and for the quantitative analysis, it was used the mean and standard deviation from each group (with and without asthma), using confidence interval (CI) 95% and heterogeneity were tested using I2 index. Furthermore, a summary of the overall strength of evidence was presented using Grading of recommendations, assessment, development, and evaluation (GRADE). 3395 studies were identified, 11 were included on this systematic review to qualitative analysis and 6 of them to quantitative synthesis. Six meta-analyses were performed to the following clinical parameters: plaque index (PI), gingival index (GI), bleeding on probing (BOP), papillary bleeding index (PBI), calculus index (CI), clinical attachment loss (CAL). The meta-analysis results for CI was (p < 0.00001, I2 = 0%) PBI (p < 0.00001, I2 = 0%), CAL (p = 0,03, I2 = 98%) showed higher means for the asthmatic group. For BOP (p = 0.20 I2 = 83%), GI (p = 0.14 I2 = 97%) and PI (p = 0.53 I2 = 95%) non-statistical difference was found. The level of evidence analysis (GRADE) presented a low level of evidence among the clinical parameters. This systematic review and meta-analysis observed that asthmatic individuals present more periodontal disease, especially gingivitis, when compared to healthy individuals, but further studies with similar methods are necessary to evaluate interactions between both diseases.
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Affiliation(s)
- Maria Karolina Martins Ferreira
- Laboratory of Structural and Functional Biology, Institute of Biological Sciences, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Railson de Oliveira Ferreira
- Laboratory of Structural and Functional Biology, Institute of Biological Sciences, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Micaele Maria Lopes Castro
- Laboratory of Structural and Functional Biology, Institute of Biological Sciences, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Marcela Barauna Magno
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Nathalia Carolina Fernandes Fagundes
- Laboratory of Structural and Functional Biology, Institute of Biological Sciences, Universidade Federal do Pará, Belém, Pará, Brazil; School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Rodrigues Lima
- Laboratory of Structural and Functional Biology, Institute of Biological Sciences, Universidade Federal do Pará, Belém, Pará, Brazil.
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Picado C, Pernigotti A, Arismendi E. Asthma: A New Cardiovascular Risk Factor? Arch Bronconeumol 2018; 55:353-354. [PMID: 30559032 DOI: 10.1016/j.arbres.2018.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 12/01/2022]
Affiliation(s)
- César Picado
- Servicio de Neumología y Alergia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), España
| | - Alberto Pernigotti
- Servicio de Cardiología, Hospital Clínic de Barcelona, Barcelona, España
| | - Ebymar Arismendi
- Servicio de Neumología y Alergia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), España.
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Asthma is associated with carotid arterial injury in children: The Childhood Origins of Asthma (COAST) Cohort. PLoS One 2018; 13:e0204708. [PMID: 30261051 PMCID: PMC6160166 DOI: 10.1371/journal.pone.0204708] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/12/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Asthma is associated with an increased cardiovascular disease (CVD) risk in adults, but the impact of asthma and atopic conditions on CVD risk in children is less well established. We hypothesized that children in the Childhood Origins of Asthma (COAST) Cohort with asthma and atopic conditions would have early carotid arterial injury. METHODS The COAST study is a longitudinal birth cohort of children at increased risk of developing asthma. Children underwent ultrasonography measuring far wall right carotid bifurcation (RCB) and common carotid artery (RCCA) intima-media thickness (IMT; a measure of arterial injury). Multivariable linear regression models adjusted for age, gender, race, blood pressure, and body-mass index were used to assess associations of asthma and markers of arterial injury. RESULTS The 89 participants were a mean (standard deviation) 15.3 (0.6) years old and 42% were female; 28 asthmatics had atopic disease, 34 asthmatics were without other atopic disease, and 15 non-asthmatics had atopic disease. This study population was compared to 12 controls (participants free of asthma or atopic disease). Compared to controls (589 μm), those with atopic disease (653 μm, p = 0.07), asthma (649 μm, p = 0.05), or both (677 μm, p = 0.005) had progressively higher RCB IMT values (ptrend = 0.011). In adjusted models, asthmatic and/or atopic participants had significantly higher RCB IMT than those without asthma or atopic disease (all p≤0.03). Similar relationships were found for RCCA IMT. CONCLUSION Adolescents with asthma and other atopic diseases have an increased risk of subclinical arterial injury compared to children without asthma or other atopic disease.
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Keet CA, McCormack M. Cardiac Asthma: An Old Term That May Have New Meaning? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 4:924-5. [PMID: 27587322 DOI: 10.1016/j.jaip.2016.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Corinne A Keet
- Division of Pediatric Allergy and Immunology, Johns Hopkins School of Medicine, Baltimore, Md.
| | - Meredith McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Md
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Tuleta I, Eckstein N, Aurich F, Nickenig G, Schaefer C, Skowasch D, Schueler R. Reduced longitudinal cardiac strain in asthma patients. J Asthma 2018; 56:350-359. [PMID: 29668337 DOI: 10.1080/02770903.2018.1466311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE There is limited knowledge about the potential relationship between asthma and heart function. Aim of our present study was to examine if asthma may be associated with manifest or subclinical heart dysfunction. METHODS Seventy-two allergic mild-to-moderate and severe asthma patients and 20 matched controls were enrolled in the study. Depending on the anti-asthmatic therapy, four subgroups of asthma patients were created: patients under long-acting beta2-agonists (LABA) and inhaled cortisone without oral cortisone treatment with (1a) versus without (1b) additional omalizumab therapy; patients with LABA, inhaled cortisone and omalizumab treatment with (2a) versus without (2b) oral cortisone. Standard echocardiographic parameters as well as global longitudinal left and right ventricular strains as determined by ultrasound-based speckle-tracking method were evaluated. Furthermore, NT-pro-brain natriuretic peptide (NT-pro-BNP), immunoglobulin E (IgE), C-reactive protein (CRP), and blood count were assessed in asthma and control groups. RESULTS There were no relevant differences in standard echocardiographic measures between both asthma groups and the control collective. Longitudinal left ventricular strain values were reduced significantly in severe and mild-to-moderate asthma groups (-12.91 ± 0.84% and -13.92 ± 1.55%, respectively), whereas longitudinal right ventricular strain values were additionally relevantly decreased in severe asthma (-10.35 ± 1.04%) compared to the control (-16.55 ± 0.49% and -18.48 ± 1.90%, respectively). Cardiac strains were similar in subgroups 1a and 1b. In contrast, patients from subgroup 2a presented reduced heart strains and decreased lung function compared to those from 2b. CRP, IgE, and eosinophils were significantly increased in asthma versus control individuals. CONCLUSIONS Allergic asthma, especially severe asthma is associated with subclinical impaired left and right ventricular function as determined by speckle-tracking analysis.
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Affiliation(s)
- I Tuleta
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - N Eckstein
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - F Aurich
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - G Nickenig
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - C Schaefer
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - D Skowasch
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - R Schueler
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
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Trinh HKT, Ban GY, Lee JH, Park HS. Leukotriene Receptor Antagonists for the Treatment of Asthma in Elderly Patients. Drugs Aging 2017; 33:699-710. [PMID: 27709465 DOI: 10.1007/s40266-016-0401-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Elderly asthma (EA) is regarded as a distinct phenotype of asthma and is associated with age-related changes in airway structure and alterations in lung function and immune responses. EA is difficult to diagnose because of aging and co-morbidities, and overlaps with fixed airway obstructive disease. Novel modalities to differentiate between EA and chronic obstructive pulmonary disease (COPD) are necessary. A multifaceted approach, including clinical history, smoking habits, atopy, and measurement of lung function, is mandatory to differentiate asthma from COPD. There are a variety of co-morbidities with EA, of which COPD, upper airway diseases, depression, obesity, and hypertension are the most common, and these co-morbidities can affect the control status of EA. However, leukotriene receptor antagonists (LTRAs) can facilitate the management of EA, and thus addition of an LTRA to inhaled corticosteroid (ICS) monotherapy or ICS plus long-acting β2-agonist therapy improves symptoms in EA patients. LTRA treatment is safe and beneficial in patients who are unable to use inhalation devices properly or who have co-morbid diseases. Therefore, clinical studies targeting a specific population of EA patients are warranted to help achieve a better therapeutic strategy in EA patients.
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Affiliation(s)
- Hoang Kim Tu Trinh
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea
| | - Ga-Young Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea
| | - Ji-Ho Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Worldcup-ro 164, Youngtong-gu, Suwon-si, 443-380, South Korea. .,Department of Biomedical Sciences, The Graduate School, Ajou University, Suwon, South Korea.
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Wang L, Gao S, Yu M, Sheng Z, Tan W. Association of asthma with coronary heart disease: A meta analysis of 11 trials. PLoS One 2017; 12:e0179335. [PMID: 28609456 PMCID: PMC5469478 DOI: 10.1371/journal.pone.0179335] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/26/2017] [Indexed: 12/12/2022] Open
Abstract
PURPOSE While the relationship of asthma and coronary heart disease (CHD) (a specific manifestation of cardiovascular disease) has not been described consistently, we tried to defined this relation and explore the influence of gender and asthma status (child- and adult-onset asthma) on this issue. METHODS We searched published reports that described the relationship of asthma and CHD. RESULTS Eleven trials were identified, covering 666,355 subjects. Asthma overall was significantly associated with CHD both for prospective trials (HR 1.34 [1.09,1.64], P = 0.005) and for retrospective trials(OR 1.29 [1.13,1.46], P = 0.001), when compared to individuals without asthma. Subgroup analysis split by gender indicated that females with asthma were significantly associated with CHD (HR 1.40 [1.20,1.62], P<0.001), but males with asthma were not significantly related with CHD (HR 1.19 [0.98,1.44], P = 0.07). For the four subgroups (Females with adult-onset asthma,males with adult-onset asthma,females with child-onset asthma,and males with child-onset asthma), pooled analysis of two trials indicated that only females with adult-onset asthma were significantly associated with CHD (HR 2.06 [1.32,3.19], P<0.001). CONCLUSIONS Our data indicated that asthma was associated with CHD, and the relationship between them seemed to derived mostly from females with adult-onset asthma. Considering the limits of our study, these findings should be taken with caution.
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Affiliation(s)
- Lida Wang
- Department of E.N.T, Weifang People’s Hospital, Weifang, China
| | - Shuyan Gao
- Department of Hematology, Weifang People’s Hospital, Weifang, China
| | - Mingdong Yu
- Department of Orthopaedics, Weifang People’s Hospital, Weifang, China
| | - Zhixin Sheng
- Department of Hematology, Weifang People’s Hospital, Weifang, China
| | - Wei Tan
- Department of Respiration, Weifang People’s Hospital, Weifang, China
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Iribarren C, Rahmaoui A, Long AA, Szefler SJ, Bradley MS, Carrigan G, Eisner MD, Chen H, Omachi TA, Farkouh ME, Rothman KJ. Cardiovascular and cerebrovascular events among patients receiving omalizumab: Results from EXCELS, a prospective cohort study in moderate to severe asthma. J Allergy Clin Immunol 2017; 139:1489-1495.e5. [DOI: 10.1016/j.jaci.2016.07.038] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/23/2016] [Accepted: 07/01/2016] [Indexed: 12/21/2022]
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Liu H, Fu Y, Wang K. Asthma and risk of coronary heart disease: A meta-analysis of cohort studies. Ann Allergy Asthma Immunol 2017; 118:689-695. [PMID: 28433577 DOI: 10.1016/j.anai.2017.03.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/02/2017] [Accepted: 03/14/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Few studies have investigated the incidence of coronary heart disease (CHD) in patients with asthma, and their results remain inconclusive. OBJECTIVE To conduct a meta-analysis to determine whether asthma increases the risk of CHD. METHODS A systematic literature search of the PubMed and Embase databases from inception to August 2016, complemented with references screening of relevant articles and reviews, was performed to identify eligible studies. Only longitudinal cohort studies were included in our meta-analysis. RESULTS The retrieval process yielded 7 studies (12 asthma cohorts) with 495,024 patients. Data pooling across the cohorts revealed that asthma was associated with an increased risk of CHD (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.30-1.57; P < .001), without significant heterogeneity across the studies (I2 = 26%, P = .19). This epidemiologic association was more pronounced in female than in male patients (female: HR, 1.50; 95% CI, 1.41-1.59; male: HR, 1.31; 95% CI, 1.16-1.47; P for interaction = .046). In addition, subgroup and sensitivity analyses supported the positive correlation between asthma and incident CHD. CONCLUSION Asthma is related to an increased incidence of CHD, particularly in women. Clinicians should be aware of this association when faced with a patient with asthma. Further investigations are required to examine how this excess risk should be managed in routine practice.
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Affiliation(s)
- Huai Liu
- Department of Respiratory Medicine, Jingmen No. 2 People's Hospital, Jingmen, Hubei, China.
| | - Ying Fu
- Medical School of Jingchu University of Technology, Jingmen, Hubei, China
| | - Kunpeng Wang
- Hubei University of Medicine, Shiyan, Hubei, China
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Rolfes MC, Juhn YJ, Wi CI, Sheen YH. Asthma and the Risk of Rheumatoid Arthritis: An Insight into the Heterogeneity and Phenotypes of Asthma. Tuberc Respir Dis (Seoul) 2017; 80:113-135. [PMID: 28416952 PMCID: PMC5392483 DOI: 10.4046/trd.2017.80.2.113] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/03/2016] [Accepted: 12/08/2016] [Indexed: 01/05/2023] Open
Abstract
Asthma is traditionally regarded as a chronic airway disease, and recent literature proves its heterogeneity, based on distinctive clusters or phenotypes of asthma. In defining such asthma clusters, the nature of comorbidity among patients with asthma is poorly understood, by assuming no causal relationship between asthma and other comorbid conditions, including both communicable and noncommunicable diseases. However, emerging evidence suggests that the status of asthma significantly affects the increased susceptibility of the patient to both communicable and noncommunicable diseases. Specifically, the impact of asthma on susceptibility to noncommunicable diseases such as chronic systemic inflammatory diseases (e.g., rheumatoid arthritis), may provide an important insight into asthma as a disease with systemic inflammatory features, a conceptual understanding between asthma and asthma-related comorbidity, and the potential implications on the therapeutic and preventive interventions for patients with asthma. This review discusses the currently under-recognized clinical and immunological phenotypes of asthma; specifically, a higher risk of developing a systemic inflammatory disease such as rheumatoid arthritis and their implications, on the conceptual understanding and management of asthma. Our discussion is divided into three parts: literature summary on the relationship between asthma and the risk of rheumatoid arthritis; potential mechanisms underlying the association; and implications on asthma management and research.
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Affiliation(s)
| | - Young Jun Juhn
- Department of Pediatric and Adolescent Medicine/Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Youn Ho Sheen
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, Korea
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Tattersall MC, Barnet JH, Korcarz CE, Hagen EW, Peppard PE, Stein JH. Late-Onset Asthma Predicts Cardiovascular Disease Events: The Wisconsin Sleep Cohort. J Am Heart Assoc 2016; 5:e003448. [PMID: 27559071 PMCID: PMC5079014 DOI: 10.1161/jaha.116.003448] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Asthma is a heterogeneous syndrome with different clinical subtypes that is associated with an increased risk for cardiovascular disease (CVD). We hypothesized that the late-onset subtype of asthma is associated with a higher risk of incident CVD. METHODS AND RESULTS Participants from the Wisconsin Sleep Cohort free of CVD at baseline were followed for a mean (SD) of 13.9 (5.9) years for development of CVD (myocardial infarction, angina, stroke, coronary revascularization, heart failure, or CVD death). Late-onset asthma was defined as physician-diagnosed asthma at age ≥18 years. Multivariable Cox regression models adjusted for age, sex, and CVD risk factors were used to assess associations of late-onset asthma and incident CVD. The 1269 participants were 47.3 (8.0) years old; 166 participants had asthma (111 late-onset, 55 early-onset). Participants with late-onset asthma compared to nonasthmatics were more likely to be female (67% versus 44%) and to have a higher body-mass index (32.2 versus 29.4 kg/m(2)) (P<0.05). Mean age of asthma diagnosis in the late-onset group was 39.5 (9.6) years versus 8.9 (5.7) years in the early-onset group (P<0.0001). Late-onset asthmatics had a higher adjusted risk of incident CVD than nonasthmatics (hazard ratio 1.57, 95% CI 1.01-2.45, P=0.045). There was no interaction between body-mass index and age of asthma diagnosis on incident CVD (P=0.83). CONCLUSIONS In a large cohort study of adults followed prospectively for over a decade, late-onset asthmatics had an increased risk of incident CVD events that persisted after adjustment for age, sex, and CVD risk factors.
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Affiliation(s)
- Matthew C Tattersall
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jodi H Barnet
- Department of Population Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Claudia E Korcarz
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Erika W Hagen
- Department of Population Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Paul E Peppard
- Department of Population Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - James H Stein
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Bang DW, Wi CI, Kim EN, Hagan J, Roger V, Manemann S, Lahr B, Ryu E, Juhn YJ. Asthma Status and Risk of Incident Myocardial Infarction: A Population-Based Case-Control Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:917-23. [PMID: 27157653 DOI: 10.1016/j.jaip.2016.02.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 01/25/2016] [Accepted: 02/18/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND The role of asthma status and characteristics of asthma in the risk of myocardial infarction (MI) are poorly understood. OBJECTIVE We determined whether asthma and its characteristics are associated with risk of MI. METHODS The study was designed as a population-based retrospective case-control study, which included all eligible incident MI cases between November 1, 2002, and May 31, 2006, and their matched controls. Asthma was ascertained using predetermined criteria. Active (current) asthma was defined as the occurrence of asthma-related episodes (asthma symptoms, use of asthma medications, unscheduled medical or emergency department visit, or hospitalization for asthma) within 1 year before MI index date. RESULTS There were 543 eligible incident MI cases during the study period. Of the 543 MI cases, 81 (15%) had a history of asthma before index date of MI, whereas 52 of 543 controls (10%) had such a history (adjusted odds ratio [OR]: 1.68; 95% CI: 1.06-2.66) adjusting for risk factors for MI and comorbid conditions (excluding chronic obstructive lung disease). Although inactive asthma did not increase the risk of MI, individuals with active asthma had a higher odds of MI, compared with those without asthma (adjusted OR: 3.18; 95% CI: 1.57-6.44) without controlling for chronic obstructive pulmonary disease (COPD). After adjusting for COPD, although asthma overall was no longer statistically significant (adjusted OR: 1.34, 95% CI: 0.84-2.15), active asthma still was associated (adjusted OR: 2.33, 95% CI: 1.12-4.82). CONCLUSION Active asthma is an unrecognized risk factor for MI. Further studies are needed to assess the role of asthma control and medications in the risk of MI.
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Affiliation(s)
- Duk Won Bang
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, South Korea
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn
| | - Eun Na Kim
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, South Korea
| | - John Hagan
- Division of Allergic Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minn
| | - Veronique Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minn
| | - Sheila Manemann
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Brian Lahr
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Department of Internal Medicine, Mayo Clinic, Rochester, Minn.
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Kankaanranta H, Kauppi P, Tuomisto LE, Ilmarinen P. Emerging Comorbidities in Adult Asthma: Risks, Clinical Associations, and Mechanisms. Mediators Inflamm 2016; 2016:3690628. [PMID: 27212806 PMCID: PMC4861800 DOI: 10.1155/2016/3690628] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 01/07/2023] Open
Abstract
Asthma is a heterogeneous disease with many phenotypes, and age at disease onset is an important factor in separating the phenotypes. Most studies with asthma have been performed in patients being otherwise healthy. However, in real life, comorbid diseases are very common in adult patients. We review here the emerging comorbid conditions to asthma such as obesity, metabolic syndrome, diabetes mellitus type 2 (DM2), and cardiac and psychiatric diseases. Their role as risk factors for incident asthma and whether they affect clinical asthma are evaluated. Obesity, independently or as a part of metabolic syndrome, DM2, and depression are risk factors for incident asthma. In contrast, the effects of comorbidities on clinical asthma are less well-known and mostly studies are lacking. Cross-sectional studies in obese asthmatics suggest that they may have less well controlled asthma and worse lung function. However, no long-term clinical follow-up studies with these comorbidities and asthma were identified. These emerging comorbidities often occur in the same multimorbid adult patient and may have in common metabolic pathways and inflammatory or other alterations such as early life exposures, systemic inflammation, inflammasome, adipokines, hyperglycemia, hyperinsulinemia, lung mechanics, mitochondrial dysfunction, disturbed nitric oxide metabolism, and leukotrienes.
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Affiliation(s)
- Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
- Department of Respiratory Medicine, University of Tampere, 33521 Tampere, Finland
| | - Paula Kauppi
- Department of Respiratory Medicine and Allergology, Skin and Allergy Hospital, Helsinki University Hospital and Helsinki University, 00029 Helsinki, Finland
| | - Leena E. Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
| | - Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
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Comorbid diseases in aspirin-exacerbated respiratory disease, and asthma. Allergol Immunopathol (Madr) 2015; 43:442-8. [PMID: 25547458 DOI: 10.1016/j.aller.2014.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 07/22/2014] [Accepted: 07/31/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Asthma, persistent rhinosinusitis, and/or nasal polyposis accompanying non-steroidal anti-inflammatory drug (NSAID) intolerance is defined as aspirin-exacerbated respiratory disease (AERD). Although the literature includes considerable data on comorbidities in asthma, data on comorbidities in AERD have not been previously published. OBJECTIVE This study aimed to determine the prevalence of comorbidities in AERD and compare the findings to those in asthmatic patients. MATERIALS AND METHODS The records for 330 AERD patients that presented to our allergy clinic were reviewed. Patients with urticaria/angio-oedema type reactions to NSAIDs were included in the pseudo Samter's group (n=83) and 338 randomly selected NSAID-tolerant asthma patients constituted the control group. RESULTS Gender, age at presentation, age at onset of asthma, and follow-up periods were similar in all groups. Hypertension (P=0.035), diabetes mellitus (P=0.323), gastro-oesophageal reflux (P<0.001), psychological disorders (P=0.099), obesity (P=0.003), and hyperlipidaemia (P=0.002) were significantly more prevalent in the asthma group. Interestingly, coronary artery disease (CAD) and congestive heart failure (CHF) were more common in the AERD group (P=0.178); CAD/CHF was associated with AERD (OR: 4.5; 95% CI: 1.206-16.93). CONCLUSION AERD and asthma are associated with several comorbidities. Even though systemic steroid dependency and severe asthma were significantly more common in the AERD group, comorbidities occurred more frequently in the asthma group. Additional longitudinal studies are needed to more clearly discern if the risk of CAD/CHF is increased in AERD.
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Hoy HM, O'Keefe LC. Practical guidance on the recognition of uncontrolled asthma and its management. J Am Assoc Nurse Pract 2015; 27:466-75. [PMID: 26119777 DOI: 10.1002/2327-6924.12284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/12/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE To highlight the significance of asthma in primary care and offer a practitioner-friendly interpretation of the asthma guidelines for the busy provider, while introducing new treatment options currently in clinical trials, such as the once-daily long-acting anticholinergic bronchodilator tiotropium Respimat. DATA SOURCES Articles with relevant adult data published between 2004 and 2015 were identified via PubMed. Additional references were obtained by reviewing bibliographies from selected articles. CONCLUSIONS In the United States, uncontrolled or symptomatic asthma is common, with rates of 46%-78% in primary care. Uncontrolled asthma has a substantial impact on patients' quality of life and represents a significant healthcare burden. Nurse practitioners can improve patients' asthma control through education, monitoring, assessment, and treatment. Although asthma management guidelines are readily available, the authors recognize that nurse practitioners see patients with multiple comorbidities, all of which have treatment guidelines of their own. IMPLICATIONS FOR PRACTICE Nurse practitioners have a compelling opportunity as frontline caregivers and patient educators to recognize and assess uncontrolled asthma, along with determining the steps necessary to help patients gain and maintain symptom control.
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Affiliation(s)
- Haley M Hoy
- College of Nursing, University of Alabama in Huntsville, Huntsville, Alabama
| | - Louise C O'Keefe
- College of Nursing, University of Alabama in Huntsville, Huntsville, Alabama
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Sun WX, Zhang JR, Li Y, Wang RT. Reply to the Letter to the Editor: Arterial stiffness in patients with bronchial asthma; role of hypertension and antihypertensive drugs. Respir Med 2015; 109:1491-2. [PMID: 26412804 DOI: 10.1016/j.rmed.2015.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Wen-Xue Sun
- Department of Respiratory, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Ji-Rong Zhang
- Department of Geriatrics, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Ying Li
- Department of Geriatrics, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China; International Physical Examination and Healthy Center, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Rui-Tao Wang
- Department of Geriatrics, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China.
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Tattersall MC, Guo M, Korcarz CE, Gepner AD, Kaufman JD, Liu KJ, Barr RG, Donohue KM, McClelland RL, Delaney JA, Stein JH. Asthma predicts cardiovascular disease events: the multi-ethnic study of atherosclerosis. Arterioscler Thromb Vasc Biol 2015; 35:1520-5. [PMID: 25908767 DOI: 10.1161/atvbaha.115.305452] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/13/2015] [Indexed: 11/16/2022]
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. The presence and severity of asthma were assessed in the MESA at examination 1. Persistent asthma was defined as asthmatics using controller medications (inhaled corticosteroids, leukotriene inhibitors, and oral corticosteroids) and intermittent asthma as asthmatics not using controller medications. Participants were followed up for a mean (SD) of 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 6792 participants were 62.2 (SD, 10.2) years old: 47% men (28% black, 22% Hispanic, and 12% Chinese). Persistent asthmatics (n=156), compared with intermittent (n=511) and nonasthmatics (n=6125), respectively, had higher C-reactive protein (1.2 [1.2] versus 0.9 [1.2] versus 0.6 [1.2] mg/L) and fibrinogen (379 [88] versus 356 [80] versus 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 nonasthmatics 90.2% (89.4%-91%). Persistent asthmatics had greater risk of CVD events than nonasthmatics (hazard ratio [95% confidence interval], 1.6 [1.01-2.5]; P=0.040]), even after adjustment for age, sex, race, CVD risk factors, and antihypertensive and lipid medication use. CONCLUSIONS In this large multiethnic cohort, persistent asthmatics had a higher CVD event rate than nonasthmatics.
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Affiliation(s)
- Matthew C Tattersall
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., C.E.K., A.D.G., J.H.S.); Department of Biostatistics (M.G.) and Department of Epidemiology (J.D.K., J.A.D.), University of Washington School of Public Health, Seattle; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University and Mailman School of Public Health, Columbia University, New York, NY (R.G.B.); and Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University, New York, NY (K.M.D.)
| | - Mengye Guo
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., C.E.K., A.D.G., J.H.S.); Department of Biostatistics (M.G.) and Department of Epidemiology (J.D.K., J.A.D.), University of Washington School of Public Health, Seattle; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University and Mailman School of Public Health, Columbia University, New York, NY (R.G.B.); and Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University, New York, NY (K.M.D.)
| | - Claudia E Korcarz
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., C.E.K., A.D.G., J.H.S.); Department of Biostatistics (M.G.) and Department of Epidemiology (J.D.K., J.A.D.), University of Washington School of Public Health, Seattle; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University and Mailman School of Public Health, Columbia University, New York, NY (R.G.B.); and Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University, New York, NY (K.M.D.)
| | - Adam D Gepner
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., C.E.K., A.D.G., J.H.S.); Department of Biostatistics (M.G.) and Department of Epidemiology (J.D.K., J.A.D.), University of Washington School of Public Health, Seattle; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University and Mailman School of Public Health, Columbia University, New York, NY (R.G.B.); and Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University, New York, NY (K.M.D.)
| | - Joel D Kaufman
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., C.E.K., A.D.G., J.H.S.); Department of Biostatistics (M.G.) and Department of Epidemiology (J.D.K., J.A.D.), University of Washington School of Public Health, Seattle; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University and Mailman School of Public Health, Columbia University, New York, NY (R.G.B.); and Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University, New York, NY (K.M.D.)
| | - Kiang J Liu
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., C.E.K., A.D.G., J.H.S.); Department of Biostatistics (M.G.) and Department of Epidemiology (J.D.K., J.A.D.), University of Washington School of Public Health, Seattle; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University and Mailman School of Public Health, Columbia University, New York, NY (R.G.B.); and Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University, New York, NY (K.M.D.)
| | - R Graham Barr
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., C.E.K., A.D.G., J.H.S.); Department of Biostatistics (M.G.) and Department of Epidemiology (J.D.K., J.A.D.), University of Washington School of Public Health, Seattle; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University and Mailman School of Public Health, Columbia University, New York, NY (R.G.B.); and Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University, New York, NY (K.M.D.)
| | - Kathleen M Donohue
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., C.E.K., A.D.G., J.H.S.); Department of Biostatistics (M.G.) and Department of Epidemiology (J.D.K., J.A.D.), University of Washington School of Public Health, Seattle; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University and Mailman School of Public Health, Columbia University, New York, NY (R.G.B.); and Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University, New York, NY (K.M.D.)
| | - Robyn L McClelland
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., C.E.K., A.D.G., J.H.S.); Department of Biostatistics (M.G.) and Department of Epidemiology (J.D.K., J.A.D.), University of Washington School of Public Health, Seattle; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University and Mailman School of Public Health, Columbia University, New York, NY (R.G.B.); and Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University, New York, NY (K.M.D.)
| | - Joseph A Delaney
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., C.E.K., A.D.G., J.H.S.); Department of Biostatistics (M.G.) and Department of Epidemiology (J.D.K., J.A.D.), University of Washington School of Public Health, Seattle; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University and Mailman School of Public Health, Columbia University, New York, NY (R.G.B.); and Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University, New York, NY (K.M.D.)
| | - James H Stein
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., C.E.K., A.D.G., J.H.S.); Department of Biostatistics (M.G.) and Department of Epidemiology (J.D.K., J.A.D.), University of Washington School of Public Health, Seattle; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University and Mailman School of Public Health, Columbia University, New York, NY (R.G.B.); and Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University, New York, NY (K.M.D.).
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Battaglia S, Basile M, Spatafora M, Scichilone N. Are asthmatics enrolled in randomized trials representative of real-life outpatients? Respiration 2015; 89:383-9. [PMID: 25791779 DOI: 10.1159/000375314] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/02/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/OBJECTIVE This study was aimed at exploring to what extent populations enrolled in randomized controlled trials (RCTs) of inhalation combination treatment for mild/moderate asthma in adults are fully representative of 'real-life' populations. The following is a retrospective analysis of the clinical records of outpatient subjects with an ascertained diagnosis of asthma. METHODS A retrospective analysis was performed. Stable conditions, such as smoking habit and chronic diseases other than asthma, were identified as exclusion criteria for RCTs. The selected criteria were then applied to asthmatic outpatients, yielding a population that was potentially eligible for RCTs. RESULTS Out of 1,909 subjects, 824 (43.2%) met at least one of the exclusion criteria for RCTs. Cigarette smoking (occurring in 34.3% of the entire population), lung diseases other than asthma (5.0%), anxiety and depression (3.3%), arrhythmias (2.3%), and coronary artery disease (1.2%) would have been the most frequent causes for exclusion from RCTs. The proportion of patients excluded from RCTs appears to increase with age, reaching 57.1% in patients aged >85 years. CONCLUSIONS In a real-life setting, >40% of subjects with mild/moderate asthma are currently treated by protocols based on the results of RCTs for which they would not have been eligible. This proportion increases in elderly patients with comorbidities. These findings limit the generalizability of RCTs and advocate that complementary pragmatic studies be conducted. © 2015 S. Karger AG, Basel.
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Affiliation(s)
- Salvatore Battaglia
- Sezione di Malattie Cardio-Respiratorie ed Endocrino-Metaboliche, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
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Kauppi P, Kupiainen H, Lindqvist A, Haahtela T, Laitinen T. Long-term smoking increases the need for acute care among asthma patients: a case control study. BMC Pulm Med 2014; 14:119. [PMID: 25030656 PMCID: PMC4108236 DOI: 10.1186/1471-2466-14-119] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 07/03/2014] [Indexed: 11/12/2022] Open
Abstract
Background To examine risk factors for asthma patients’ emergency room (ER) visits in a well organized asthma care setting. Methods A random sample of 344 asthma patients from a Pulmonary Clinic of a University Hospital were followed through medical records from 1995 to 2006. All the ER visits due to dyspnea, respiratory infections, chest pain, and discomfort were evaluated. Results The mean age of the study population was 56 years (SD 13 years), 72% being women. 117 (34%) of the patients had had at least one ER visit during the follow-up (mean 0.5 emergency visits per patient year, range 0–7). Asthma exacerbation, lower and upper respiratory infections accounted for the 71% of the ER visits and 77% of the hospitalizations. The patients with ER visits were older, had suffered longer from asthma and more frequently from chronic sinusitis, were more often ex- or current smokers, and had lower lung function parameters compared to the patients without emergency visits. Previous (HR 1.9, CI 1.3-3.1) and current smoking (HR 3.6, CI 1.6-8.2), poor self-reported health related quality of life (HRQoL) (HR 2.5, CI 1.5-4), and poor lung function (FEV1 < 65%, HR 2.2, CI 1.3-3.7) remained independent risk factors for ER visits after adjustment for age and gender. Conclusions Asthma patients who are or have been long-term smokers are more likely to require ER care compared to never smokers.
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Affiliation(s)
- Paula Kauppi
- Skin and Allergy Hospital, Helsinki University Central Hospital, PO Box 160, FI-00029 HUS Helsinki, Finland.
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Abstract
PURPOSE OF REVIEW Asthma is often associated with different comorbidities, mainly gastro-oesophageal reflux disease and allergic rhinitis, but also obesity, depression, diabetes mellitus and cardiovascular disease, which may affect its clinical intensity and severity. The prevalence of these comorbidities varies tremendously between studies. Nevertheless, it imposes a significant reflection on the need to explore the phenomenon in depth. RECENT FINDINGS Both clinical and basic studies have established that inflammation plays a vital role in the initiation and progression of several comorbidities. However, the role of systemic inflammation in asthma is still unclear. Understanding mechanism(s) that link(s) asthma and its comorbid diseases is essential to design an effective therapeutic approach. SUMMARY In the future, researchers must identify the weight of any comorbidity in patients with asthma, find the true mechanism(s) that link(s) it to asthma and act on these mechanisms that probably create a vicious circle. Conversely, we do not think it reasonable that the generalization of treatment with a holistic approach might affect the link(s) between asthma and its comorbidities.
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