Asthma is associated with cardiovascular disease in a representative population sample
Sarah L Appleton1, Richard E Ruffin1, David H Wilson1
1The Health Observatory, Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville Road, South Australia 5011, Australia.
Insights
Asthma is linked to a higher risk of cardiovascular disease (CVD) and stroke, independent of traditional risk factors like obesity. However, asthma was not associated with an increased risk of diabetes in this population study.
Area of Science:
- Cardiology
- Pulmonology
- Endocrinology
Background:
- Inflammatory mediators common to asthma and cardiovascular disease (CVD) may increase risk for CVD and insulin resistance.
- This study investigated the association between asthma, CVD/stroke, and diabetes in a population-based sample, considering obesity's role.
Purpose of the Study:
- To determine if asthma prevalence is associated with increased CVD/stroke and diabetes.
- To examine if obesity modifies the relationship between asthma and these conditions.
Main Methods:
- Utilized data from the North West Adelaide Health Study (NWAHS) with 4060 participants (age ≥18).
- Assessed lung function (spirometry), anthropometry, blood pressure, glucose, HbA1c, and self-reported diagnoses of asthma, diabetes, and CVD/stroke.
- Asthma was defined by self-report or significant bronchodilator reversibility.
Main Results:
- Adjusted analyses showed asthma was not associated with diabetes (OR = 1.06, 95% CI: 0.45-2.49).
- Asthma remained significantly associated with CVD/stroke (OR = 1.82, 95% CI: 1.20-2.73) independently of BMI, smoking, and lung function.
- No interaction was found between asthma and BMI for CVD/stroke or diabetes. Asthma was not linked to CVD risk factors or metabolic syndrome.
Conclusions:
- In a population sample, asthma is associated with CVD/stroke after adjusting for traditional risk factors and lung function.
- Asthma may contribute to CVD events through mechanisms beyond established risk factors, warranting further research.
- Obesity did not significantly modify the association between asthma and CVD/stroke or diabetes.
Rationale:
People with asthma may have an increased risk of cardiovascular disease (CVD) and metabolic disorders due to the direct involvement of common inflammatory mediators in the pathogenesis of CVD and insulin resistance. The aim of this study was to determine whether asthma was associated with an increased prevalence of CVD/stroke, and diabetes in a cross-sectional population study and whether the relationship was modified by obesity.
Methods:
The North West Adelaide Health Study (NWAHS) (n = 4060, age ≥18 years) clinical assessment included spirometry, anthropometry, blood pressure, fasting lipids, glucose and HbA1c. Questionnaires assessed doctor diagnosed asthma, diabetes, CVD (myocardial infarction, angina)/stroke, smoking status, and demographics. Asthma was identified by self-report or significant bronchodilator reversibility of lung function.
Results:
After adjustment for known risk factors and confounders, asthma was not associated with diabetes (odds ratio (OR) = 1.06, 95% confidence interval (CI): 0.45-2.49, p = .91) yet remained positively associated with CVD/stroke (OR = 1.82, 95% CI: 1.20-2.73, p < 0.01) independent of the level of BMI (p for interaction between asthma and BMI = .22), smoking and lung function. Asthma was not positively associated with CVD risk factors or the metabolic syndrome.
Conclusions:
In a representative population sample, asthma was associated with CVD/stroke after adjustment for traditional risk factors and lung function. Asthma may lead to CVD events via pathways unrelated to traditional risk factors and this requires further investigation. No significant effect modification by BMI was observed in relation to CVD, or diabetes.
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