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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: 0] [Impact Index Per Article: 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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Valencia-Hernández CA, Del Greco M F, Sundaram V, Portas L, Minelli C, Bloom CI. Asthma and incident coronary heart disease: an observational and Mendelian randomisation study. Eur Respir J 2023; 62:2301788. [PMID: 37945032 PMCID: PMC10695770 DOI: 10.1183/13993003.01788-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Observational studies suggest asthma is a risk factor for coronary heart disease (CHD) and sex modifies the risk, but they may suffer from methodological limitations. To overcome these, we applied a "triangulation approach", where different methodologies, with different potential biases, were leveraged to enhance confidence in findings. METHODS First, we conducted an observational study using UK medical records to match asthma patients 1:1, by age, sex and general practitioner (GP) practice, to the general population. We measured the association between asthma and incident CHD (myocardial infarction: hospitalisation/death) by applying minimal sufficient adjustment: model 1, smoking, body mass index, oral corticosteroids, atopy and deprivation; model 2, additionally adjusting for healthcare behaviour (GP consultation frequency). Second, we conducted a Mendelian randomisation (MR) study using data from the UK Biobank, Trans-National Asthma Genetic Consortium (TAGC) and Coronary Artery Disease Genome-wide Replication and Meta-analysis consortium (CARDIoGRAM). Using 64 asthma single nucleotide polymorphisms, the effect of asthma on CHD was estimated with inverse variance-weighted meta-analysis and methods that adjust for pleiotropy. RESULTS In our observational study (n=1 522 910), we found asthma was associated with 6% increased risk of CHD (model 1: HR 1.06, 95% CI 1.01-1.13); after accounting for healthcare behaviour, we found no association (model 2: HR 0.99, 95% CI 0.94-1.05). Asthma severity did not modify the association, but sex did (females: HR 1.11, 95% CI 1.01-1.21; males: HR 0.91, 95% CI 0.84-0.98). Our MR study (n=589 875) found no association between asthma and CHD (OR 1.01, 95% CI 0.98-1.04) and no modification by sex. CONCLUSIONS Our findings suggest that asthma is not a risk factor for CHD. Previous studies may have suffered from detection bias or residual confounding.
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Affiliation(s)
| | | | - Varun Sundaram
- Louis Stokes Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Laura Portas
- National Heart and Lung Institute, Imperial College London, London, UK
- Oxford Big Data Institute, University of Oxford, Oxford, UK
| | - Cosetta Minelli
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Chloe I Bloom
- National Heart and Lung Institute, Imperial College London, London, UK
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Caplan M, Hamzaoui O. Cardio-respiratory interactions in acute asthma. Front Physiol 2023; 14:1232345. [PMID: 37781226 PMCID: PMC10540856 DOI: 10.3389/fphys.2023.1232345] [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: 05/31/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
Asthma encompasses of respiratory symptoms that occur intermittently and with varying intensity accompanied by reversible expiratory airflow limitation. In acute exacerbations, it can be life-threatening due to its impact on ventilatory mechanics. Moreover, asthma has significant effects on the cardiovascular system, primarily through heart-lung interaction-based mechanisms. Dynamic hyperinflation and increased work of breathing caused by a sharp drop in pleural pressure, can affect cardiac function and cardiac output through different mechanisms. These mechanisms include an abrupt increase in venous return, elevated right ventricular afterload and interdependence between the left and right ventricle. Additionally, Pulsus paradoxus, which reflects the maximum consequences of this heart lung interaction when intrathoracic pressure swings are exaggerated, may serve as a convenient bedside tool to assess the severity of acute asthma acute exacerbation and its response to therapy.
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Affiliation(s)
- Morgan Caplan
- Service de Médecine Intensive Réanimation, Hôpital Robert Debré, Université de Reims, Reims, France
| | - Olfa Hamzaoui
- Service de Médecine Intensive Réanimation, Hôpital Robert Debré, Université de Reims, Reims, France
- Unité HERVI, Hémostase et Remodelage Vasculaire Post-Ischémie, Reims, France
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Hansen ESH, Rasmusen HK, Hostrup M, Hellsten Y, Backer V. The effect of aerobic exercise training on asthma control in postmenopausal women (ATOM): a randomized controlled pilot study. Eur Clin Respir J 2023; 10:2251256. [PMID: 37674777 PMCID: PMC10478610 DOI: 10.1080/20018525.2023.2251256] [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: 04/13/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023] Open
Abstract
Objective To evaluate if high-intensity interval training three times weekly for 12 weeks improves asthma control in overweight, postmenopausal women with uncontrolled, late-onset asthma. Methods The reported study is a randomized clinical pilot study (www.clinicaltrials.gov; NCT03747211) that compared 12 weeks of high-intensity interval training (spinning) with usual care. The five-question Asthma Control Questionnaire (ACQ-5) was used as primary outcome. Secondary measures included systemic inflammation and inflammation of the airways, body composition, and cardiac function during exercise. Results We included 12 women with asthma (mean age 65 years (SD 6); mean body mass index 30 kg/m2 (SD 2)) from whom eight were randomized to exercise and four to control. Baseline ACQ-5 was 1.95 (SD 0.53) in the control group and 2.03 (0.54) in the exercise group. Patients had a mean blood eosinophil level of 0.16 × 109cells/L (SD 0.07) and a mean fraction of exhaled nitric oxide of 23 ppb (SD 25). Mixed models showed that participants in the exercise group reduced their ACQ-5 by 0.55 points (95%CI -1.10 to -0.00; P = 0.08) compared with the control group. The exercise group significantly reduced their mean body fat percentage (-2.7%; 95%CI -4.5 to -0.8; P = 0.02), fat mass (-2.8 kg; 95%CI -5.1 to -0.4; P = 0.044) and android fat mass (-0.33 kg; 95%CI -0.60- -0.06; P = 0.038). In analyses of cardiac measures, we saw no significant effects on right ventricular function (fractional area change), diastolic function or left ventricular function. Conclusions Although changes in ACQ-5 were slightly insignificant, these preliminary findings indicate that aerobic exercise training can be used as a means to improve asthma control in overweight, postmenopausal women with asthma.
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Affiliation(s)
- Erik Sören Halvard Hansen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
- Department of Internal Medicine, Slagelse Hospital, Slagelse, Denmark
| | | | - Morten Hostrup
- Department of Nutrition Exercise and Sports, University of Copenhagen, CopenhagenDenmark
| | - Ylva Hellsten
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, CopenhagenDenmark
| | - Vibeke Backer
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Otorhinolaryngology, Rigshospitalet, CopenhagenDenmark
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Garg VS, Sojitra MH, Ubhadiya TJ, Dubey N, Shah K, Gandhi SK, Patel P. Understanding the Link Between Adult Asthma and Coronary Artery Disease: A Narrative Review. Cureus 2023; 15:e43621. [PMID: 37719576 PMCID: PMC10504680 DOI: 10.7759/cureus.43621] [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] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Asthma is a common pathology worldwide that occurs due to chronic inflammation of the respiratory airways. Persistent pulmonary inflammation leads to low-grade systemic inflammation, influencing blood vessels and triggering coronary artery disease (CAD) events. This review's objectives include discussing the susceptible population for CAD, the mechanism underlying CAD creation in asthma patients, the characteristics of asthma, and the influence of anti-asthmatic medications on CAD development. Adult-onset asthma is strongly linked to CAD and stroke. Future research may shed light on these disparities. Atherosclerosis and asthma are linked through both intrinsic and extrinsic pathways, with inflammation being the intrinsic pathway and hypoxia and tachyarrhythmia being the extrinsic pathways. The most probable mechanisms for increased coronary vasospastic angina (CVsA) incidence in asthmatic patients are vascular smooth muscle cell hypercontraction and endothelial dysfunction. Studies have shown a dose-response relationship between asthma control and myocardial infarction (MI) risk, with uncontrolled asthma at the highest risk. Impairment of ventilatory function is a distinct risk factor for lethal MI and cardiovascular death (CVD). The use of beta-2-agonists and chronic oral glucocorticoid therapy in severe asthmatics has been linked to increasing the risk for CAD. However, some studies have shown that the risk of MI among patients with active asthma is not related to the use of asthma medications. Further research is needed to determine the involvement of adult asthma features and their treatments in the development of CAD.
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Affiliation(s)
- Vasudha S Garg
- Department of Internal Medicine, Civil Hospital Ahmedabad, Ahmedabad, IND
| | - Mihir H Sojitra
- Department of Neurology, Civil Hospital Ahmedabad, Ahmedabad, IND
| | - Tyagi J Ubhadiya
- Department of Internal Medicine, Civil Hospital Ahmedabad, Ahmedabad, IND
| | - Nidhi Dubey
- Department of Internal Medicine, Civil Hospital Ahmedabad, Ahmedabad, IND
| | - Karan Shah
- Department of Internal Medicine, Civil Hospital Ahmedabad, Ahmedabad, IND
| | - Siddharth Kamal Gandhi
- Department of Internal Medicine, Meghji Pethraj (MP) Shah Government Medical College, Jamnagar, IND
| | - Priyansh Patel
- Department of Internal Medicine, Medical College Baroda, Vadodara, IND
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Lee CJ, Hwang J, Kang CY, Kang D, Kim DH, Park HJ, Kim HC, Ihm SH, Kim YJ, Shin JH, Pyun WB, Park S. Asthma and increased risk of myocardial infarction and mortality among hypertensive Korean patients. Hypertens Res 2023; 46:1694-1704. [PMID: 36991063 DOI: 10.1038/s41440-023-01257-3] [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: 02/16/2022] [Revised: 02/25/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023]
Abstract
This study aimed to evaluate the effects of asthma on cardiovascular disease incidence in patients with hypertension. A total of 639,784 patients with hypertension from the Korea National Health Insurance Service database were included, of whom 62,517 had history of asthma after propensity score matching. The risks of all-cause mortality, myocardial infarction (MI), stroke, and end-stage renal disease (ESRD) were assessed according to the presence of asthma, long-acting β2-agonist (LABA) inhaler usage, and/or systemic corticosteroid usage for up to 11 years. In addition, whether these risks were modified by average blood pressure (BP) levels during the follow-up period was examined. Asthma was associated with an increased risk of all-cause mortality (hazard ratio [HR], 1.203; 95% confidence interval [CI], 1.165-1.241) and MI (HR, 1.244; 95% CI, 1.182-1.310) but not the risk of stroke or ESRD. LABA inhaler usage was associated with a higher risk of all-cause mortality and MI, and systemic corticosteroids usage showed a higher risk of ESRD as well as all-cause mortality and MI among hypertensive patients with asthma. Compared to patients without asthma, there was a graded increase in the risk of all-cause mortality and MI in those with asthma without LABA inhaler/systemic corticosteroid usage and in those with asthma with LABA inhaler/systemic corticosteroid usage. These associations were not significantly modified by BP levels. This nationwide population-based study supports that asthma may be a clinical factor that increases the risk of poor outcomes in patients with hypertension.
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Affiliation(s)
- Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinseub Hwang
- Department of Statistics and Computer Science, Daegu University, Gyeongsan, Gyeongbuk, Republic of Korea
| | - Chae Young Kang
- Department of Statistics and Computer Science, Daegu University, Gyeongsan, Gyeongbuk, Republic of Korea
| | - Dayoung Kang
- Department of Statistics and Computer Science, Daegu University, Gyeongsan, Gyeongbuk, Republic of Korea
| | - Do Hyang Kim
- Department of Statistics and Computer Science, Daegu University, Gyeongsan, Gyeongbuk, Republic of Korea
| | - Hye Jung Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeon-Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Division of Cardiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Wook Bum Pyun
- Cardiovascular Center, Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Nair AK, Van Hulle CA, Bendlin BB, Zetterberg H, Blennow K, Wild N, Kollmorgen G, Suridjan I, Busse WW, Dean DC, Rosenkranz MA. Impact of asthma on the brain: evidence from diffusion MRI, CSF biomarkers and cognitive decline. Brain Commun 2023; 5:fcad180. [PMID: 37377978 PMCID: PMC10292933 DOI: 10.1093/braincomms/fcad180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/27/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic systemic inflammation increases the risk of neurodegeneration, but the mechanisms remain unclear. Part of the challenge in reaching a nuanced understanding is the presence of multiple risk factors that interact to potentiate adverse consequences. To address modifiable risk factors and mitigate downstream effects, it is necessary, although difficult, to tease apart the contribution of an individual risk factor by accounting for concurrent factors such as advanced age, cardiovascular risk, and genetic predisposition. Using a case-control design, we investigated the influence of asthma, a highly prevalent chronic inflammatory disease of the airways, on brain health in participants recruited to the Wisconsin Alzheimer's Disease Research Center (31 asthma patients, 186 non-asthma controls, aged 45-90 years, 62.2% female, 92.2% cognitively unimpaired), a sample enriched for parental history of Alzheimer's disease. Asthma status was determined using detailed prescription information. We employed multi-shell diffusion weighted imaging scans and the three-compartment neurite orientation dispersion and density imaging model to assess white and gray matter microstructure. We used cerebrospinal fluid biomarkers to examine evidence of Alzheimer's disease pathology, glial activation, neuroinflammation and neurodegeneration. We evaluated cognitive changes over time using a preclinical Alzheimer cognitive composite. Using permutation analysis of linear models, we examined the moderating influence of asthma on relationships between diffusion imaging metrics, CSF biomarkers, and cognitive decline, controlling for age, sex, and cognitive status. We ran additional models controlling for cardiovascular risk and genetic risk of Alzheimer's disease, defined as a carrier of at least one apolipoprotein E (APOE) ε4 allele. Relative to controls, greater Alzheimer's disease pathology (lower amyloid-β42/amyloid-β40, higher phosphorylated-tau-181) and synaptic degeneration (neurogranin) biomarker concentrations were associated with more adverse white matter metrics (e.g. lower neurite density, higher mean diffusivity) in patients with asthma. Higher concentrations of the pleiotropic cytokine IL-6 and the glial marker S100B were associated with more salubrious white matter metrics in asthma, but not in controls. The adverse effects of age on white matter integrity were accelerated in asthma. Finally, we found evidence that in asthma, relative to controls, deterioration in white and gray matter microstructure was associated with accelerated cognitive decline. Taken together, our findings suggest that asthma accelerates white and gray matter microstructural changes associated with aging and increasing neuropathology, that in turn, are associated with more rapid cognitive decline. Effective asthma control, on the other hand, may be protective and slow progression of cognitive symptoms.
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Affiliation(s)
- Ajay Kumar Nair
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI 53703, USA
| | - Carol A Van Hulle
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Barbara B Bendlin
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA
- Wisconsin Alzheimer’s Institute, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, S-431 30 Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, S-431 30 Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London, WCIE 6BT, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, Clear Water Bay, Hong Kong SAR, China
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, S-431 30 Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, S-431 30 Mölndal, Sweden
| | - Norbert Wild
- Roche Diagnostics GmbH, Core Lab RED, 82377 Penzberg, Germany
| | | | - Ivonne Suridjan
- CDMA Clinical Development, Roche Diagnostics International Ltd, CH-6346, Rotkreuz, Switzerland
| | - William W Busse
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Douglas C Dean
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Melissa A Rosenkranz
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI 53703, USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
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Wang S, Liu H, Yang P, Wang Z, Hu P, Ye P, Xia J, Chen S. Exploring the genetic association of allergic diseases with cardiovascular diseases: a bidirectional Mendelian randomization study. Front Immunol 2023; 14:1175890. [PMID: 37334359 PMCID: PMC10272545 DOI: 10.3389/fimmu.2023.1175890] [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: 02/28/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Background In observational and experimental studies, allergic diseases (AD) have been reported to be associated with some types of cardiovascular diseases (CVD), as both share common pathophysiological processes involving inflammation and metabolic disorders. However, the direction of the causal association between them remains unclear. This Mendelian randomization (MR) study aims to examine the bidirectional causality between AD and CVD. Methods We utilized publicly available genome-wide association study (GWAS) summary statistics data from European participants in the UK Biobank and the IEU Open GWAS database. Genetic variants associated with AD, asthma, and CVD were identified and used as instrumental variables to investigate the genetically causal association between them. MR analyses were performed using various analytical methods, including inverse variance weighted-fixed effects (IVW-FE), inverse variance weighted-multiplicative random effects (IVW-RE), MR-Egger, weighted median, weighted mode, and maximum likelihood. Sensitivity tests were conducted to assess the validity of the causality. Results The MR analysis with the IVW method revealed a genetically predicted association between AD and essential hypertension [odds ratio (OR)=0.9987, 95% confidence interval (CI): 0.9976-0.9998, P=0.024], as well as between asthma and atrial fibrillation (OR=1.001, 95% CI: 1.0004-1.0017, P=6.43E-05). In the reverse MR analyses, heart failure was associated with allergic diseases (OR=0.0045, 95% CI: 1.1890E-04 - 0.1695, P=0.004), while atherosclerosis (OR=8.7371E-08, 95% CI: 1.8794E-14 - 4.0617E-01, P=0.038) and aortic aneurysm and dissection (OR=1.7367E-07, 95% CI: 3.8390E-14 - 7.8567E-01, P=0.046) might be protective factors of asthma. However, after a Bonferroni correction, only the association between asthma and atrial fibrillation remained robust. Conclusion The MR study revealed that asthma is a predominant risk of atrial fibrillation in European individuals, consistent with most experimental and observational studies. Whether AD affects other CVD and the causality between them needs further investigation.
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Affiliation(s)
- Shilin Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Liu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peiwen Yang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiwen Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Poyi Hu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Ye
- Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiahong Xia
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Hidden Comorbidities in Asthma: A Perspective for a Personalized Approach. J Clin Med 2023; 12:jcm12062294. [PMID: 36983294 PMCID: PMC10059265 DOI: 10.3390/jcm12062294] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/05/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Bronchial asthma is the most frequent inflammatory non-communicable condition affecting the airways worldwide. It is commonly associated with concomitant conditions, which substantially contribute to its burden, whether they involve the lung or other districts. The present review aims at providing an overview of the recent acquisitions in terms of asthma concomitant systemic conditions, besides the commonly known respiratory comorbidities. The most recent research has highlighted a number of pathobiological interactions between asthma and other organs in the view of a shared immunological background underling different diseases. A bi-univocal relationship between asthma and common conditions, including cardiovascular, metabolic or neurodegenerative diseases, as well as rare disorders such as sickle cell disease, α1-Antitrypsin deficiency and immunologic conditions with hyper-eosinophilia, should be considered and explored, in terms of diagnostic work-up and long-term assessment of asthma patients. The relevance of that acquisition is of utmost importance in the management of asthma patients and paves the way to a new approach in the light of a personalized medicine perspective, besides targeted therapies.
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Adrish M, Hanania NA. Asthma and cardiovascular disease: A bidirectional association? Respirology 2023; 28:217-219. [PMID: 36750439 DOI: 10.1111/resp.14468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/29/2023] [Indexed: 02/09/2023]
Affiliation(s)
- Muhammad Adrish
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA
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11
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Yu S, Lee SC, Hong JH, Han CH, Park SC, Jung JY. Cardiovascular and cerebrovascular mortality in patients with preceding asthma exacerbation. Respirology 2023; 28:281-286. [PMID: 36596607 DOI: 10.1111/resp.14444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/11/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Soojoung Yu
- International Healthcare Center, Soonchunhyang University Seoul Hospital, Yongsan-gu, South Korea
| | - Sang Chul Lee
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Jung Hwa Hong
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Chang Hoon Han
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Seon Cheol Park
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Ji Ye Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, South Korea
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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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Chan KC, Au CT, Wong E, Chook P, Li AM. Inferior endothelial function improved following optimisation of asthma control in children. Respir Med 2022; 204:107024. [DOI: 10.1016/j.rmed.2022.107024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 08/22/2022] [Accepted: 10/19/2022] [Indexed: 10/31/2022]
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14
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Farraj AK, Martin BL, Schladweiler MC, Miller CN, Smoot J, Williams W, Fisher A, Oshiro W, Tennant A, Martin WK, Henriquez AR, Grindstaff R, Gavett SH, Gilmour MI, Kodavanti UP, Hazari MS, Dye JA. Mild allergic airways responses to an environmental mixture increase cardiovascular risk in rats. Toxicol Sci 2022; 191:106-122. [PMID: 36269214 PMCID: PMC9887678 DOI: 10.1093/toxsci/kfac112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Recent epidemiological findings link asthma to adverse cardiovascular responses. Yet, the precise cardiovascular impacts of asthma have been challenging to disentangle from the potential cardiovascular effects caused by asthma medication. The purpose of this study was to determine the impacts of allergic airways disease alone on cardiovascular function in an experimental model. Female Wistar rats were intranasally sensitized and then challenged once per week for 5 weeks with saline vehicle or a mixture of environmental allergens (ragweed, house dust mite, and Aspergillus fumigatus). Ventilatory and cardiovascular function, measured using double-chamber plethysmography and implantable blood pressure (BP) telemetry and cardiovascular ultrasound, respectively, were assessed before sensitization and after single and final allergen challenge. Responses to a single 0.5 ppm ozone exposure and to the cardiac arrhythmogenic agent aconitine were also assessed after final challenge. A single allergen challenge in sensitized rats increased tidal volume and specific airways resistance in response to provocation with methacholine and increased bronchoalveolar lavage fluid (BALF) eosinophils, neutrophils, lymphocytes, cytokines interleukin (IL)-4, IL-5, IL-10, IL-1β, tumor necrosis factor-α, and keratinocyte chemoattract-growth-related oncogene characteristic of allergic airways responses. Lung responses after final allergen challenge in sensitized rats were diminished, although ozone exposure increased BALF IL-6, IL-13, IL-1 β, and interferon-γ and modified ventilatory responses only in the allergen group. Final allergen challenge also increased systolic and mean arterial BP, stroke volume, cardiac output, end-diastolic volume, sensitivity to aconitine-induced cardiac arrhythmia, and cardiac gene expression with lesser effects after a single challenge. These findings demonstrate that allergic airways responses may increase cardiovascular risk in part by altering BP and myocardial function and by causing cardiac electrical instability.
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Affiliation(s)
- Aimen K Farraj
- To whom correspondence should be addressed at US Environmental Protection Agency, 109 T.W. Alexander Drive, Mail Code: B105-02, Research Triangle Park, NC 27709, USA. E-mail:
| | - Brandi L Martin
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee 37830, USA
| | - Mette C Schladweiler
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Colette N Miller
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee 37830, USA
| | - Jacob Smoot
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee 37830, USA
| | - Wanda Williams
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Anna Fisher
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Wendy Oshiro
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Alan Tennant
- Biomolecular and Computational Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - W Kyle Martin
- Curriculum of Toxicology and Environmental Medicine, UNC Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Andres R Henriquez
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee 37830, USA
| | - Rachel Grindstaff
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee 37830, USA
| | - Stephen H Gavett
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - M Ian Gilmour
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Urmila P Kodavanti
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Mehdi S Hazari
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
| | - Janice A Dye
- Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
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15
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Bonnesen B, Sivapalan P, Kristensen AK, Lassen MCH, Skaarup KG, Rastoder E, Sørensen R, Eklöf J, Biering-Sørensen T, Jensen JUS. Major cardiovascular events in patients with severe chronic obstructive pulmonary disease with and without asthma: a nationwide cohort study. ERJ Open Res 2022; 8:00200-2022. [PMID: 36171987 PMCID: PMC9511138 DOI: 10.1183/23120541.00200-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Chronic low-grade inflammation as in asthma may lead to a higher risk of cardiovascular events. We evaluated whether patients with COPD and asthma have a higher risk of acute cardiovascular events than patients with COPD without asthma. Methods Nationwide multicentre retrospective cohort study of Danish outpatients with a specialist diagnosis of COPD with or without asthma. Patients with both COPD and asthma were propensity-score matched 1:2 to patients with COPD without asthma. The primary end-point was severe major adverse cardiac events (MACE), defined as mortal cardiovascular events and events requiring revascularisation or hospitalisation. Results A total of 52 386 Danish patients with COPD were included; 34.7% had pre-existing cardiovascular disease, and 20.1% had asthma in addition to their COPD. Patients with pre-existing cardiovascular disease were then propensity-score matched: 3690 patients with COPD and asthma versus 7236 patients with COPD without asthma, and similarly, for patients without pre-existing cardiovascular disease (6775 matched with 13 205). The risk of MACE was higher among patients with asthma and COPD versus COPD without asthma: hazard ratio (HR) 1.25 (95% CI 1.13–1.39, p<0.0001) for patients with pre-existing cardiovascular disease and HR 1.22 (95% CI 1.06–1.41, p=0.005) for patients without pre-existing cardiovascular disease. Conclusion Among patients with COPD, asthma as a comorbid condition is associated with substantially increased risk of cardiovascular events. The signal was an increased risk of 20–25%. Based on our study and other smaller studies, asthma can be considered a risk factor for cardiovascular events among COPD patients. Among patients with COPD and pre-existing cardiovascular disease, asthma as a comorbid condition is associated with substantially increased risk of cardiovascular events.https://bit.ly/3uEtA3r
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16
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Tian J, Shi H, Wang X, Wu H, Wang C, Liu N, Wang D, Shi D, Zhang H, Zhang Z. The cardiotoxicity of asthmatic rats after traffic-related PM 2.5 and water-soluble components exposure mediated by endoplasmic reticulum stress and autophagy. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:50704-50716. [PMID: 35235115 DOI: 10.1007/s11356-022-19496-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Abstract
Fine particulate matter (PM2.5) is closely related to cardiopulmonary diseases; it is known that the respiratory system is related to the cardiovascular system. This study aimed to investigate the toxic effects of traffic-related PM2.5 (TRPM2.5) and water-soluble components (WSC) on hearts of asthmatic rats and explore potential molecular mechanisms. Here, ovalbumin (OVA)-sensitized asthmatic rats were intratracheally instilled with TRPM2.5 and WSC every 3 days in total of eight times. Significant myocardial pathological changes were observed in the TRPM2.5 and WSC group by hematoxylin-eosin (HE) staining. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) results demonstrated TRPM2.5 and WSC aggravated apoptosis of myocardial cells, which may be triggered by endoplasmic reticulum stress (ERS), as manifested by elevated GRP78, CHOP, and caspase-12. Likewise, TRPM2.5 and WSC activated autophagy via upregulation of LC3 and p62 gene and protein expression. In conclusion, TRPM2.5 and WSC may aggravate heart injury in asthmatic rats, possibly through the activation of ERS and autophagy signaling pathway.
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Affiliation(s)
- Jiayu Tian
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China
| | - Hao Shi
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China
| | - Xin Wang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China
| | - Hongyan Wu
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China
| | - Caihong Wang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China
| | - Nannan Liu
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China
| | - Dan Wang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China
| | - Dongxing Shi
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China
| | - Hongmei Zhang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China
| | - Zhihong Zhang
- Department of Environmental Health, School of Public Health, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi, China.
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17
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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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18
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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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19
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Geng C, Feng Y, Yang Y, Yang H, Li Z, Tang Y, Wang J, Zhao H. Allergic asthma aggravates angiotensin Ⅱ-induced cardiac remodeling in mice. Transl Res 2022; 244:88-100. [PMID: 35108660 DOI: 10.1016/j.trsl.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/13/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
Cardiovascular disease remains the leading cause of death globally, and heart failure (HF) represents its terminal stage. Asthma, one of the most common chronic diseases, has been reported to be associated with an increased risk of cardiovascular disease. However, the link between asthma and HF has rarely been studied, and the possible mechanisms by which asthma affects HF are unclear. This study aimed to explore the influence of asthma on HF and the possible mechanisms. We analyzed data from the National Health and Nutrition Examination Survey and found a higher prevalence of HF among asthmatic individuals, and identified an independent association between HF and asthma. Subsequently, we produced mice with concurrent ovalbumin (OVA) sensitization-induced allergic asthma and angiotensin Ⅱ infusion-induced cardiac remodeling to explore the effect of asthma on cardiac remodeling in vivo. The results showed that OVA-induced asthma impaired heart function and aggravated cardiac remodeling in mice. We also found that OVA sensitization increased the expression levels of immunoglobulin E (IgE) in serum and IgE receptor (FcεR1) in the heart, and enhanced the activation of downstream signaling molecules of IgE-FcεR1 in the heart. Importantly, blockage of IgE-FcεR1 using FcεR1-deficient mice or an anti-IgE antibody prevented asthma-induced decline of cardiac function, and alleviated cardiac remodeling. These findings demonstrate the adverse effects of allergic asthma on the heart, and suggest the potential application of anti-IgE therapy in the treatment of asthma complicated with heart conditions.
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Key Words
- AKT, protein kinase B
- ANP, natriuretic peptide type A
- Ang Ⅱ, angiotensin Ⅱ
- BALF, bronchioalveolar lavage fluid
- BMI, body mass index
- BNP, natriuretic peptide type B
- BW, body weight
- CAD, coronary heart disease
- COPD, chronic obstructive pulmonary disease
- CVD, cardiovascular disease
- EF, ejection fraction
- FS, fraction shortening
- HF, heart failure
- HW, heart weight
- IgE, immunoglobulin E
- LVAW, left ventricular anterior wall
- LVID, left ventricular internal dimension
- LVPW, left ventricular posterior wall
- NHANES, National Health and Nutrition Examination Survey
- OVA, ovalbumin
- TC, total cholesterol
- TG, triglyceride
- WGA, wheat germ agglutinin
- WT, wild type
- pSmad2/3, phosphorylated small mothers against decapentaplegic 2 and 3
- α-SMA, α-smooth muscle actin
- β-MHC, β-myosin heavy chain
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Affiliation(s)
- Chi Geng
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yufan Feng
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yang Yang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Hongqin Yang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Zhiwei Li
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yaqin Tang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Jing Wang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.
| | - Hongmei Zhao
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.
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20
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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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21
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Zhang B, Li ZF, An ZY, Zhang L, Wang JY, Hao MD, Jin YJ, Li D, Song AJ, Ren Q, Chen WB. Association Between Asthma and All-Cause Mortality and Cardiovascular Disease Morbidity and Mortality: A Meta-Analysis of Cohort Studies. Front Cardiovasc Med 2022; 9:861798. [PMID: 35369308 PMCID: PMC8968068 DOI: 10.3389/fcvm.2022.861798] [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: 01/25/2022] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAsthma and cardiovascular disease (CVD) share many risk factors. Previous meta-analyses indicated that asthma is associated with an increased risk of CVD and all-cause mortality, but these studies were limited by unstandardized search strategies and the number of articles included.ObjectiveWe sought to systematically synthesize evidence investigating the impact of asthma on all-cause mortality and CVD morbidity and mortality.MethodsWe searched in PubMed and EMBASE for observational cohort studies (inception dates to November 10, 2021) that had both asthma groups and control groups. We also manually searched the reference lists of correlative articles to include other eligible studies. Data for associations between asthma and all-cause mortality and CVD morbidity and mortality were needed.ResultsWe summarized the findings from 30 cohort studies comprising 4,157,823 participants. Asthma patients had increased CVD morbidity [relative risk (RR) = 1.28, 95% confidence interval (CI) = 1.16–1.40] and increased CVD mortality (RR = 1.25, 95% CI = 1.14–1.38). Asthma patients also had increased risk of all-cause mortality (RR = 1.38, 95% CI = 1.07–1.77). In subgroup analyses, female asthma patients had a higher risk of CVD morbidity and all-cause mortality than male asthma patients, and late-onset asthma patients had a higher risk of CVD morbidity than early-onset asthma patients.ConclusionAsthma patients have increased risk of all-cause mortality and CVD morbidity and mortality. This information reminds clinicians to be aware of the risk of CVD and all-cause mortality in asthma patients.Systematic Review Registrationhttp://www.crd.york.ac.uk/PROSPERO/, PROSPERO, identifier: CRD 42021290082.
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Affiliation(s)
- Bin Zhang
- Department of Cardiovascular Disease and Clinical Experimental Center, Jiangmen Central Hospital, Jiangmen, China
| | - Zhi-Fei Li
- Aerospace Center Hospital, Beijing, China
| | - Zhuo-Yu An
- Peking University People's Hospital, Beijing, China
| | - Li Zhang
- Aerospace Center Hospital, Beijing, China
| | | | | | - Yi-Jing Jin
- Peking University First Hospital, Beijing, China
| | - Dong Li
- Department of Intensive Care Unit and Clinical Experimental Center, Jiangmen Central Hospital, Jiangmen, China
| | - An-Jian Song
- Department of Cardiovascular Disease and Clinical Experimental Center, Jiangmen Central Hospital, Jiangmen, China
| | - Qiang Ren
- Department of Cardiovascular Disease and Clinical Experimental Center, Jiangmen Central Hospital, Jiangmen, China
| | - Wen-Biao Chen
- Department of Respiratory Medicine, People's Hospital of Longhua, The Affiliated Hospital of Southern Medical University, Shenzhen, China
- *Correspondence: Wen-Biao Chen
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22
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Grigorieva NY, Ilushina TP, Kolosova KS. The possibilities of using beta-blocker bisoprolol in patients with stable angina with concomitant bronchial asthma. KARDIOLOGIIA 2022; 62:32-39. [PMID: 35168531 DOI: 10.18087/cardio.2022.1.n1714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/29/2021] [Indexed: 06/14/2023]
Abstract
Aim To compare efficacy and safety of treatments with the calcium antagonist (CA) verapamil, the cardioselective β-blocker (BB) bisoprolol, and a combination therapy with bisoprolol and amlodipine in patients with stable angina (SA) with concurrent mild and moderate, persistent bronchial asthma (BA). Material and methods This open, prospective, randomized, comparative study included 120 patients with an IHD+BA comorbidity. Of these patients, 60 had mild persistent BA and 60 had moderate persistent BA. Each group was divided into 3 subgroup, each including 20 patients, based on the used regimen of antianginal therapy. Stepwise dose titration was performed every 2 weeks (subgroup 1 received the BB bisoprolol 2.5 mg - 5 mg - 10 mg; subgroup 2 received the CA verapamil 240 mg - 240 mg - 240 mg; subgroup 3 received bisoprolol 2.5 mg followed by the combination treatment with bisoprolol and amlodipine as a fixed combination 5+5 mg). All patients underwent a complete clinical and instrumental examination at baseline and at 2, 4, and 6 weeks of treatment. The antianginal effectivity and the effect on bronchial patency were evaluated. Results In patients with SA and mild persistent BA, the study of external respiration function (ERF) at 2, 4, and 6 weeks of treatment did not detect any significant difference in the forced expiratory volume in 1 second (FEV1) between the treatment subgroups. In patients with SA and moderate persistent BA receiving the treatment, a significant decrease in FEV1 (р=0.022) was observed in subgroup 1 receiving bisoprolol 10 mg at 6 weeks of treatment. In subgroups 2 and 3 during the treatment, significant differences were absent. In patients with SA and mild or moderate persistent BA, the heart rate was significantly decreased in all three subgroups; however, in subgroup 2 receiving verapamil, the changes were considerably smaller than in other subgroups.Conclusion The study results showed that the BB bisoprolol with dose titration every two weeks from 2.5 to 10 mg or the combination treatment with the BB bisoprolol and the CA amlodipine can be used as the antianginal therapy in patients with SA and mild persistent BA. The BB bisoprolol may be used in patients with SA and moderate persistent BA as the antianginal therapy, but only at doses not exceeding 5 mg to avoid the development of bronchial obstruction. The combination therapy with the BB bisoprolol 5 mg and the CA amlodipine 5 mg is indicated to enhance antianginal and vasoprotective effects.
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Affiliation(s)
- N Yu Grigorieva
- National Research N.I. Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
| | - T P Ilushina
- "Central City Hospital of Arzamas", Arzamas, Russia
| | - K S Kolosova
- National Research N.I. Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
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23
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Winder B, Kiechl SJ, Gruber NM, Bernar B, Gande N, Staudt A, Stock K, Hochmayr C, Geiger R, Griesmacher A, Anliker M, Kiechl S, Kiechl-Kohlendorfer U, Knoflach M. The association of allergic asthma and carotid intima-media thickness in adolescence: data of the prospective early vascular ageing (EVA)-Tyrol cohort study. BMC Cardiovasc Disord 2022; 22:11. [PMID: 35042472 PMCID: PMC8764773 DOI: 10.1186/s12872-021-02452-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In recent years, there has been increasing evidence that asthma is associated with atherosclerosis and cardiovascular disease. However, data in children and adolescents are scarce and conflicting. We aimed to assess the impact of asthma with and without an allergic component on the carotid intima-media thickness in a large pediatric population. METHODS The community-based early vascular ageing-Tyrol cohort study was performed between May 2015 and July 2018 in North, East (Austria) and South Tyrol (Italy) and recruited youngster aged 14 years and above. Medical examinations included anthropometric measurements, fasting blood analysis, measurement of the carotid intima-media thickness by high-resolution ultrasound, and a physician guided interview. RESULTS The mean age of the 1506 participants was 17.8 years (standard deviation 0.90). 851 (56.5%) participants were female. 22 subjects had a physician diagnosis of non-allergic asthma, 268 had inhalative allergies confirmed by a positive radio-allergo-sorbent-test and/or prick test, and 58 had allergic asthma. Compared to healthy controls, participants with non-allergic asthma (411.7 vs. 411.7 µm; p = 0.932) or inhalative allergy (420.0 vs. 411.7 µm; p = 0.118) did not have significantly higher carotid intima-media thickness (cIMT). However, participants with allergic asthma had significantly higher cIMT (430.8 vs. 411.7; p = 0.004) compared to those without and this association remained significant after multivariable adjustment for established cardiovascular risk factors. CONCLUSION Allergic asthma in the youth is associated with an increased carotid intima-media thickness. Physicians should therefore be aware of allergic asthma as a potential cardiovascular risk factor in children and adolescents. Trial Registration Number The EVA-Tyrol Study has been retrospectively registered at clinicaltrials.gov under NCT03929692 since April 29, 2019.
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Affiliation(s)
- Bernhard Winder
- Department of Pediatrics II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
- VASCage, Research Centre on Vascular Ageing and Stroke, Innrain 66a, 6020, Innsbruck, Austria
| | - Sophia J Kiechl
- VASCage, Research Centre on Vascular Ageing and Stroke, Innrain 66a, 6020, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Nadja M Gruber
- VASCage, Research Centre on Vascular Ageing and Stroke, Innrain 66a, 6020, Innsbruck, Austria
| | - Benoît Bernar
- Department of Pediatrics II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
- Department of Pediatrics I, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Nina Gande
- Department of Pediatrics II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Anna Staudt
- Department of Pediatrics II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Katharina Stock
- Department of Pediatrics II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
- Department of Pediatrics III, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christoph Hochmayr
- Department of Pediatrics II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Ralf Geiger
- Department of Pediatrics III, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute of Clinical Chemistry and Laboratory Medicine (ZIMCL), Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Markus Anliker
- Central Institute of Clinical Chemistry and Laboratory Medicine (ZIMCL), Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Stefan Kiechl
- VASCage, Research Centre on Vascular Ageing and Stroke, Innrain 66a, 6020, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | | | - Michael Knoflach
- VASCage, Research Centre on Vascular Ageing and Stroke, Innrain 66a, 6020, Innsbruck, Austria.
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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24
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Cardiovascular Morbidity in Individuals with Impaired FEV1. Curr Cardiol Rep 2022; 24:163-182. [PMID: 35038132 DOI: 10.1007/s11886-022-01636-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW This review is intended to give an overview of the epidemiology of cardiovascular morbidity and mortality in patients with impaired lung function with an emphasis on patients with COPD. RECENT FINDINGS Despite shared risk factors, lung disease is an emerging independent risk factor for cardiovascular disease and cardio-vascular disease (CVD) outcomes. Both CVD and chronic lung disease contribute significantly to overall mortality. Especially patients with chronic obstructive pulmonary disease (COPD) are at high risk for CVD-related mortality. In patients with chronic lung disease, a low index of suspicion should be maintained to assess for CVD and vice versa. Early detection of chronic lung disease as a potentially modifiable CVD risk factor could have important impact on patient outcomes.
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25
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Tupper OD, Andersen ZJ, Ulrik CS. Demographic, lifestyle and comorbid risk factors for all-cause mortality in a Danish cohort of middle-aged adults with incident asthma. BMJ Open 2021; 11:e049243. [PMID: 34607861 PMCID: PMC8491292 DOI: 10.1136/bmjopen-2021-049243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We aimed to identify factors associated with all-cause mortality in adults with incident asthma. DESIGN AND SETTING Cross-sectional cohort study, in the metropolitan areas of Copenhagen and Aarhus, Denmark. PARTICIPANTS Adults aged 50-64 years enrolled in the Danish Diet, Cancer, and Health cohort were followed up from baseline (1993-1997) in the National Patients Registry for first-time admissions for asthma and vital status. We defined incident asthma as at least one first-time hospital admission with asthma as the primary registered diagnosis between baseline and end of follow-up (2013) in participants without previously known asthma. Among the cohort comprising 57 053 individuals, we identified 785 adults (aged 50-64) with incident asthma, of whom 76 died during follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES Baseline reported socioeconomic and lifestyle traits, and comorbidities associated with all-cause mortality. RESULTS Self-reported leisure-time physical activity was associated with a substantial reduction in risk with an HR of 0.53 (95% CI 0.33 to 0.85). Being male, single and having a diagnosis of hypertension or diabetes were associated with an increased risk of all-cause mortality with an HR of 1.83 (95% CI 1.14 to 2.38), 2.16 (95% CI 2.06 to 4.40), 2.47 (95% CI 1.54 to 3.95) and of 2.42 (95% CI 0.96 to 6.11), respectively. CONCLUSIONS This long-term study of adults with hospital contacts for incident asthma revealed that self-reported leisure-time physical activity is associated with an approximately 50% reduction in all-cause mortality. In contrast, both hypertension and diabetes were associated with a higher risk of mortality.
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Affiliation(s)
| | - Zorana Jovanovic Andersen
- Section of Environmental Health, University of Copenhagen Department of Public Health, Kobenhavn, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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26
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Pollevick ME, Xu KY, Mhango G, Federmann EG, Vedanthan R, Busse P, Holguin F, Federman AD, Wisnivesky JP. The Relationship Between Asthma and Cardiovascular Disease: An Examination of the Framingham Offspring Study. Chest 2021; 159:1338-1345. [PMID: 33316236 PMCID: PMC8501004 DOI: 10.1016/j.chest.2020.11.053] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/13/2020] [Accepted: 11/16/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although asthma has been suggested as a risk factor for cardiovascular disease (CVD), robust longitudinal evidence of this relationship is limited. RESEARCH QUESTION Using Framingham Offspring Cohort data, the goal of this study was to longitudinally examine the association between asthma and lifetime risk of CVD while controlling for cardiovascular risk factors included in the Framingham Risk Score. STUDY DESIGN AND METHODS Data were analyzed from a prospective population-based cohort of 3,612 individuals, ages 17 to 77 years, who participated in Framingham Offspring Study examinations from 1979 to 2014. Asthma was defined based on physician diagnosis during study interviews. Incident CVD included myocardial infarction, angina, coronary insufficiency, stroke, transient ischemic attack, and heart failure. Time-dependent Cox regression models were used to evaluate the relationship between asthma and CVD incidence. RESULTS Overall, 533 (15%) participants had a diagnosis of asthma and 897 (25%) developed CVD during the course of the study. Unadjusted analyses revealed that asthma was associated with increased CVD incidence (hazard ratio, 1.40; 95% CI, 1.17-1.68). Cox regression also showed an adjusted association between asthma and CVD incidence (hazard ratio, 1.28; 95% CI, 1.07-1.54) after controlling for established cardiovascular risk factors. INTERPRETATION This prospective analysis with > 35 years of follow-up shows that asthma is a risk factor for CVD after adjusting for potential confounders. When assessing risk of cardiovascular disease, asthma should be evaluated and managed as a risk factor contributing to morbidity and mortality.
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Affiliation(s)
- Matias E Pollevick
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Feinberg School of Medicine at Northwestern University, Chicago, IL
| | - Kevin Y Xu
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Grace Mhango
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emily G Federmann
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rajesh Vedanthan
- Department of Population Health, New York University School of Medicine, New York, NY; Department of Medicine, New York University School of Medicine, New York, NY
| | - Paula Busse
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Allergy and Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Fernando Holguin
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Colorado, Denver, CO
| | - Alex D Federman
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
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27
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Corlateanu A, Stratan I, Covantev S, Botnaru V, Corlateanu O, Siafakas N. Asthma and stroke: a narrative review. Asthma Res Pract 2021; 7:3. [PMID: 33608061 PMCID: PMC7896413 DOI: 10.1186/s40733-021-00069-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/04/2021] [Indexed: 02/08/2023] Open
Abstract
Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation, bronchial reversible obstruction and hyperresponsiveness to direct or indirect stimuli. It is a severe disease causing approximately half a million deaths every year and thus possessing a significant public health burden. Stroke is the second leading cause of death and a major cause of disability worldwide. Asthma and asthma medications may be a risk factors for developing stroke. Nevertheless, since asthma is associated with a variety of comorbidities, such as cardiovascular, metabolic and respiratory, the increased incidence of stroke in asthma patients may be due to a confounding effect. The purpose of this review is to analyze the complex relationship between asthma and stroke.
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Affiliation(s)
- A. Corlateanu
- Department of Internal Medicine, Division of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Stefan cel Mare street 165, 2004 Chisinau, Republic of Moldova
| | - Iu Stratan
- Department of Internal Medicine, Division of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Stefan cel Mare street 165, 2004 Chisinau, Republic of Moldova
| | - S. Covantev
- Department of Internal Medicine, Division of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Stefan cel Mare street 165, 2004 Chisinau, Republic of Moldova
| | - V. Botnaru
- Department of Internal Medicine, Division of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy, Stefan cel Mare street 165, 2004 Chisinau, Republic of Moldova
| | - O. Corlateanu
- Department of Internal Medicine, Nicolae Testemitanu State University of Medicine and Pharmacy, Stefan cel Mare street 165, 2004 Chisinau, Republic of Moldova
| | - N. Siafakas
- Department of Thoracic Medicine, University General Hospital, Stavrakia, 71110 Heraklion, Crete, Greece
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28
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Russell AE, Mars B, Wen CP, Chang SS, Gunnell D. Evidence for an association between inflammatory markers and suicide: a cohort study based on 359,849 to 462,747 Taiwanese adults. J Affect Disord 2021; 281:967-971. [PMID: 33250203 DOI: 10.1016/j.jad.2020.10.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 09/05/2020] [Accepted: 10/25/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Biological markers of suicide risk have the potential to inform prevention and treatment efforts. It has recently been hypothesised that inflammation may influence mood and in turn suicide risk. We investigated the association between indicators of systemic inflammation and suicide in a large cohort of Taiwanese adults. METHODS White blood cell (WBC) count and levels of C-reactive protein (CRP) were measured in 462,747 and 359,849 adults in the Taiwan MJ cohort, respectively. The associations between WBC, CRP and suicide risk were investigated using Cox proportional hazards models adjusting for a range of potential confounding factors. RESULTS During a mean 15.1 and 15.8 years of follow-up, 687 and 605 suicides were identified in participants who had information on WBC and CRP respectively. There was an association of suicide with WBC count (adjusted hazard ratio [aHR] = 1.13 per 1 standard deviation increase of log-transformed WBC, 95% confidence interval [CI] 1.05, 1.22). The association was driven by the highest quintile of WBC count (aHR = 1.39, 95% CI 1.09, 1.77; reference: the lowest quintile). No association between CRP and suicide was found. LIMITATIONS Our cohort was from a privately-run health check-up programme and had a lower suicide rate than that in the general population. CONCLUSIONS Individuals with the highest WBC counts may have increased risk of suicide. Peripheral markers of inflammation are potential biomarkers of suicide risk; however, this seems to vary by population and the marker investigated and could be influenced by a range of confounding factors.
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Affiliation(s)
- Abigail Emma Russell
- Institute for Health Research, University of Exeter College of Medicine and Health, UK
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol, UK; National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol UK
| | - Chi Pang Wen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan; China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences and Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan; Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan.
| | - David Gunnell
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol, UK; National Institute of Health Research Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol UK
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Adults with current asthma but not former asthma have higher all-cause and cardiovascular mortality: a population-based prospective cohort study. Sci Rep 2021; 11:1329. [PMID: 33446724 PMCID: PMC7809422 DOI: 10.1038/s41598-020-79264-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/24/2020] [Indexed: 12/02/2022] Open
Abstract
Higher mortality in asthmatics has been shown previously. However, evidence on different asthma phenotypes on long-term mortality risk is limited. The aim was to evaluate the impact of asthma phenotypes on mortality in general population. Data from the National Health and Nutrition Examination Survey from 2001–2002 to 2013–2014 linked mortality files through December 31, 2015, were used (N = 37,015). Cox proportional hazards regression was used to estimate the risk of all-cause and cause-specific mortality adjusting for sociodemographic characteristics, smoking, body mass index, and chronic conditions. During the mean follow-up time of 7.5 years, 4326 participants died from a variety of causes. Current asthma, but not former asthma was associated with increased all-cause mortality (current asthma: HR = 1.37; 95% CI 1.20–1.58; Former asthma: HR = 0.93; 95% CI 0.73–1.18); as well as mortality from cardiovascular disease (HRCurrent = 1.41; 95% CI 1.08–1.85) and chronic lower respiratory diseases (HRCurrent = 3.17; 95% CI 1.96–5.14). In addition, we found that the HR for cardiovascular disease (CVD) mortality was slightly greater in people with childhood-onset asthma than those with adult-onset asthma. The HR for chronic lower respiratory diseases (CLRD) mortality was greater in people with adult-onset asthma than those with childhood-onset asthma. However, the differences were not statistically significant. Our study suggested that current asthma but not former asthma was associated with increased all-cause, CLRD and CVD mortality. Future well-designed studies with larger sample are required to demonstrate the association and clarify the potential mechanisms involved.
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30
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Bui DS, Lodge CJ, Perret JL, Lowe A, Hamilton GS, Thompson B, Giles G, Tan D, Erbas B, Pirkis J, Cicuttini F, Cassim R, Bowatte G, Thomas P, Garcia-Aymerich J, Hopper J, Abramson MJ, Walters EH, Dharmage SC. Trajectories of asthma and allergies from 7 years to 53 years and associations with lung function and extrapulmonary comorbidity profiles: a prospective cohort study. THE LANCET RESPIRATORY MEDICINE 2020; 9:387-396. [PMID: 33217367 DOI: 10.1016/s2213-2600(20)30413-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Longitudinal trajectories of asthma and allergies from childhood to adulthood might be differentially associated with lung function and chronic obstructive pulmonary disease (COPD), but associations with extrapulmonary comorbidities have not been well investigated. We aimed to assess these trajectories and examine their associations with lung function outcomes and profiles of comorbidities. METHODS In this prospective cohort study, data for asthma and related allergic conditions (ie, eczema, hay fever, and food allergy) were prospectively collected from the Tasmanian Longitudinal Health Study for participants aged 7-53 years originally recruited in Tasmania, Australia. All surviving individuals in the database with contact details were invited in the most recent follow-up (mean age 53 years). There were no exclusion criteria. With use of latent class analysis, we identified longitudinal trajectories of asthma and allergic conditions from 7-53 years, and profiles of self-reported extrapulmonary conditions recorded at 53 years. The associations between asthma and allergy trajectories and morbidity profiles and lung function at 53 years were investigated with regression models. FINDINGS Between Sept 3, 2012, and Nov 8, 2016, of 6128 individuals invited, 3609 (58·9%) individuals were enrolled. We identified five asthma and allergy trajectories: minimal and least asthma and allergies (n= 1767 [49·0%]); late-onset hay fever, no asthma (n=1065 [29·5%]); early-onset remitted asthma and allergies (n=236 [6·5%]); late-onset asthma and allergies (n=317 [8·8%]); and early-onset persistent asthma and allergies (n=224 [6·2%]); and four profiles of extrapulmonary morbidities: minimal or least disease (n=2206 [61·1%]); dominant mental health disorders (n=861 [23·9%]); dominant cardiovascular diseases or risks (n=424 [11·7%]); and multiple disorders (n=117 [3·2%]). The late-onset asthma and allergies trajectory was predominantly associated with the multiple disorders profile (relative risk ratio 3·3 [95% CI 1·9-5·9]), whereas the other asthma and allergy trajectories were associated only with the dominant mental health disorders profile. Both spirometrically defined and clinical COPD were most strongly associated with the early-onset persistent asthma and allergies trajectory (odds ratio [OR] 5·3 [95% CI 3·2-8·6]) and also with the late-onset asthma and allergies trajectory (OR 3·8 [2·4-6·1]). INTERPRETATION Distinct longitudinal trajectories of asthma and allergic disease from childhood to 53 years are associated with different profiles of extrapulmonary comorbidities and varying risk of COPD. These findings can inform a personalised approach in clinical guidelines and management focusing on treatable traits. Comorbidity profiles are a new target for early identification and intervention. FUNDING National Health and Medical Research Council of Australia, EU's Horizon 2020, The University of Melbourne, Clifford Craig Medical Research Trust of Tasmania, The Victorian, Queensland & Tasmanian Asthma Foundations, The Royal Hobart Hospital, Helen MacPherson Smith Trust, and GlaxoSmithKline.
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Affiliation(s)
- Dinh S Bui
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Heidelberg, Melbourne, VIC, Australia
| | - Adrian Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Garun S Hamilton
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia; Monash Lung and Sleep, Monash Health, Clayton, VIC, Australia
| | | | - Graham Giles
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Daniel Tan
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Flavia Cicuttini
- Musculoskeletal Unit, Monash University, Melbourne, VIC, Australia; Alfred Hospital, Melbourne, VIC, Australia
| | - Raisa Cassim
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Paul Thomas
- Prince of Wales' Hospital Clinical School and School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Centro de Investigación Biomédica, Epidemiología y Salud Pública, Barcelona, Spain
| | - John Hopper
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael J Abramson
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Eugene H Walters
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
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Aerts R, Dujardin S, Nemery B, Van Nieuwenhuyse A, Van Orshoven J, Aerts JM, Somers B, Hendrickx M, Bruffaerts N, Bauwelinck M, Casas L, Demoury C, Plusquin M, Nawrot TS. Residential green space and medication sales for childhood asthma: A longitudinal ecological study in Belgium. ENVIRONMENTAL RESEARCH 2020; 189:109914. [PMID: 32980008 DOI: 10.1016/j.envres.2020.109914] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/03/2020] [Accepted: 07/03/2020] [Indexed: 05/03/2023]
Abstract
BACKGROUND Living in green environments has been associated with various health benefits, but the evidence for positive effects on respiratory health in children is ambiguous. OBJECTIVE To investigate if residential exposure to different types of green space is associated with childhood asthma prevalence in Belgium. METHODS Asthma prevalence was estimated from sales data of reimbursed medication for obstructive airway disease (OAD) prescribed to children between 2010 and 2014, aggregated at census tract level (n = 1872) by sex and age group (6-12 and 13-18 years). Generalized log-linear mixed effects models with repeated measures were used to estimate effects of relative covers of forest, grassland and garden in the census tract of the residence on OAD medication sales. Models were adjusted for air pollution (PM10), housing quality and administrative region. RESULTS Consistent associations between OAD medication sales and relative covers of grassland and garden were observed (unadjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, β = 0.15-0.17; garden, β = 0.13-0.17). The associations remained significant after adjusting for housing quality and chronic air pollution (adjusted parameter estimates per IQR increase of relative cover, range across four strata: grassland, β = 0.10-0.14; garden, β = 0.07-0.09). There was no association between OAD medication sales and forest cover. CONCLUSIONS Based on aggregated data, we found that living in close proximity to areas with high grass cover (grasslands, but also residential gardens) may negatively impact child respiratory health. Potential allergic and non-allergic mechanisms that underlie this association include elevated exposure to grass pollen and fungi and reduced exposure to environmental biodiversity. Reducing the dominance of grass in public and private green space might be beneficial to reduce the childhood asthma burden and may simultaneously improve the ecological value of urban green space.
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Affiliation(s)
- Raf Aerts
- Risk and Health Impact Assessment, Sciensano (Belgian Institute of Health), Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium; Division Ecology, Evolution and Biodiversity Conservation, University of Leuven (KU Leuven), Kasteelpark Arenberg 31-2435, BE-3001, Leuven, Belgium; Division Forest, Nature and Landscape, University of Leuven (KU Leuven), Celestijnenlaan 200E-2411, BE-3001, Leuven, Belgium; Center for Environmental Sciences, University of Hasselt, Agoralaan D, BE-3590, Diepenbeek, Hasselt, Belgium; Mycology and Aerobiology, Sciensano (Belgian Institute of Health), Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium.
| | - Sebastien Dujardin
- Division Forest, Nature and Landscape, University of Leuven (KU Leuven), Celestijnenlaan 200E-2411, BE-3001, Leuven, Belgium; Department of Geography, Institute of Life Earth and Environment (ILEE), University of Namur, Namur, Belgium
| | - Benoit Nemery
- Center for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Herestraat 49-706, BE-3000, Leuven, Belgium
| | - An Van Nieuwenhuyse
- Risk and Health Impact Assessment, Sciensano (Belgian Institute of Health), Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium; Center for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Herestraat 49-706, BE-3000, Leuven, Belgium
| | - Jos Van Orshoven
- Division Forest, Nature and Landscape, University of Leuven (KU Leuven), Celestijnenlaan 200E-2411, BE-3001, Leuven, Belgium
| | - Jean-Marie Aerts
- Division Animal and Human Health Engineering, University of Leuven (KU Leuven), Leuven, Belgium
| | - Ben Somers
- Division Forest, Nature and Landscape, University of Leuven (KU Leuven), Celestijnenlaan 200E-2411, BE-3001, Leuven, Belgium
| | - Marijke Hendrickx
- Mycology and Aerobiology, Sciensano (Belgian Institute of Health), Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium
| | - Nicolas Bruffaerts
- Mycology and Aerobiology, Sciensano (Belgian Institute of Health), Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium
| | - Mariska Bauwelinck
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Pleinlaan 5, BE-1050, Brussels, Belgium
| | - Lidia Casas
- Center for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Herestraat 49-706, BE-3000, Leuven, Belgium; Epidemiology and Social Medicine, University of Antwerp, Universiteitsplein 1-R.232, BE-2610, Wilrijk, Antwerp, Belgium
| | - Claire Demoury
- Risk and Health Impact Assessment, Sciensano (Belgian Institute of Health), Juliette Wytsmanstraat 14, BE-1050, Brussels, Belgium
| | - Michelle Plusquin
- Center for Environmental Sciences, University of Hasselt, Agoralaan D, BE-3590, Diepenbeek, Hasselt, Belgium
| | - Tim S Nawrot
- Center for Environmental Sciences, University of Hasselt, Agoralaan D, BE-3590, Diepenbeek, Hasselt, Belgium; Center for Environment and Health, Department of Public Health and Primary Care, University of Leuven, Herestraat 49-706, BE-3000, Leuven, Belgium
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Shih HI, Chao TY, Huang YT, Tu YF, Sung TC, Wang JD, Chang CM. Increased Medical Visits and Mortality among Adults with Cardiovascular Diseases in Severely Affected Areas after Typhoon Morakot. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186531. [PMID: 32911725 PMCID: PMC7558838 DOI: 10.3390/ijerph17186531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 12/22/2022]
Abstract
Natural disasters have negative health impacts on chronic diseases in affected populations. Severely affected areas are usually rural areas with limited basic infrastructure and a population have that has limited access to optimal healthcare after a disaster. Patients with cardiovascular diseases are required to maintain quality care, especially after disasters. A population-based case-control study enrolled adults from the National Health Insurance Registry who had ischemic heart disease and cerebrovascular disease histories and lived in the area affected by Typhoon Morakot in 2009. Monthly medical visits for acute cerebrovascular and ischemic heart diseases markedly increased at approximately 1–2 months after the typhoon. Survival analysis during the two years following the typhoon indicated a significant increase in mortality in adults with an acute ischemic heart disease history who lived in the severely affected area. Mortality hazard analysis showed that among affected adults with previous cerebrovascular diseases and acute ischemic heart diseases, patients with diabetes (adjusted hazard ratio [HR]: 1.3–1.7), Chronic Kidney Disease (CKD) (adjusted HR: 2.0–2.7), chronic obstructive pulmonary diseases (COPD) and asthma (adjusted HR: 1.7–2.1), liver cirrhosis (adjusted HR: 2.3–3.3) and neoplasms (adjusted HR: 1.1–2.1) had significantly increased mortality rates. Consequently, high-quality and accessible primary healthcare plans should be made available to maintain and support affected populations after disasters.
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Affiliation(s)
- Hsin-I Shih
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan;
- School of Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (Y.-T.H.); (Y.-F.T.)
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Tzu-Yuan Chao
- Department of Urban Planning, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Yi-Ting Huang
- School of Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (Y.-T.H.); (Y.-F.T.)
| | - Yi-Fang Tu
- School of Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (Y.-T.H.); (Y.-F.T.)
- Department of Paediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Tzu-Ching Sung
- School of Medicine for International Students, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Chia-Ming Chang
- School of Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan; (Y.-T.H.); (Y.-F.T.)
- Division of Geriatrics & Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 70403, Taiwan
- Correspondence:
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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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Asthma, asthma control and risk of acute myocardial infarction: HUNT study. Eur J Epidemiol 2019; 34:967-977. [PMID: 31512117 DOI: 10.1007/s10654-019-00562-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/06/2019] [Indexed: 01/27/2023]
Abstract
Asthma, a chronic inflammatory airway disease, shares several common pathophysiological mechanisms with acute myocardial infarction (AMI). Our aim was to assess the prospective associations between asthma, levels of asthma control and risk of AMI. We followed 57,104 adults without previous history of AMI at baseline from Nord-Trøndelag health study (HUNT) in Norway. Self-reported asthma was categorised as active asthma (i.e., using asthma medication) and non-active asthma (i.e., not using asthma medication). Levels of asthma control were defined as controlled, partly controlled, and uncontrolled based on the Global Initiative for Asthma guidelines. AMI was ascertained by linking HUNT data with hospital records. A total of 2868 AMI events (5.0%) occurred during a mean (SD) follow-up of 17.2 (5.4) years. Adults with active asthma had an estimated 29% higher risk of developing AMI [adjusted hazard ratio (HR) 1.29, 95% CI 1.08-1.54] compared with adults without asthma. There was a significant dose-response association between asthma control and AMI risk, with highest risk in adults with uncontrolled asthma (adjusted HR 1.73, 95% CI 1.13-2.66) compared to adults with controlled asthma (p for trend < 0.05). The associations were not explained by smoking status, physical activity and C-reactive protein levels. Our study suggests that active asthma and poor asthma control are associated with moderately increased risk of AMI. Further studies are needed to evaluate causal relationship and the underlying mechanisms and to clarify the role of asthma medications in the risk of AMI.
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Raita Y, Camargo CA, Faridi MK, Brown DFM, Shimada YJ, Hasegawa K. Risk of Acute Myocardial Infarction and Ischemic Stroke in Patients with Asthma Exacerbation: A Population-Based, Self-Controlled Case Series Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:188-194.e8. [PMID: 31323338 DOI: 10.1016/j.jaip.2019.06.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/20/2019] [Accepted: 06/28/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with asthma have a high incidence of acute myocardial infarction and ischemic stroke. OBJECTIVE To investigate the acute effect of asthma exacerbation on these cardiovascular events. METHODS Using population-based inpatient data of 3 geographically diverse US states (Florida, Nebraska, and New York) during the period 2011 to 2014, we conducted a self-controlled case series study of adults (aged ≥40 years) hospitalized with asthma exacerbation. The primary outcome was a composite of acute myocardial infarction and ischemic stroke. We used conditional Poisson regression to compare each patient's incidence rate of the outcome during 3 sequential risk periods (1-7, 8-14, and 15-28 days after asthma exacerbation) with that of the reference period (ie, summed period before and after the 3 risk periods). RESULTS We identified 4607 adults hospitalized for asthma exacerbation who had a first episode of acute myocardial infarction or ischemic stroke. During the reference period, the incidence rate of acute myocardial infarction or ischemic stroke was 25.0/100 person-years. Compared with the reference period, the incidence rate significantly increased during the first risk period (129.1/100 person-years), with a corresponding adjusted incidence rate ratio of 5.04 (95% CI, 4.29-5.88; P < .001). In the 2 subsequent risk periods, the incidence rate declined but remained high-50.1/100 person-years (adjusted incidence rate ratio, 1.96; 95% CI, 1.51-2.48; P < .001) and 38.0/100 person-years (adjusted incidence rate ratio, 1.48; 95% CI, 1.20-1.81; P < .001), respectively. The findings were similar when the 2 outcomes were examined separately. CONCLUSIONS In this population-based study of adults with asthma, the risk of acute myocardial infarction and ischemic stroke increased significantly after asthma exacerbation.
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Affiliation(s)
- Yoshihiko Raita
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Mohammad Kamal Faridi
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - David F M Brown
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Yuichi J Shimada
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
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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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