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Persistent Asthma Is Associated With Increased Risk for Incident Atrial Fibrillation in the MESA
Matthew C Tattersall1, Alison S Dasiewicz1,2, Robyn L McClelland2
1Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., A.D.G., M.M.K., M.H.H., J.H.S.).
Background:
Asthma and atrial fibrillation (AF) share an underlying inflammatory pathophysiology. We hypothesized that persistent asthmatics are at higher risk for developing AF and that this association would be attenuated by adjustment for baseline markers of systemic inflammation.
Methods:
The MESA (Multi-Ethnic Study of Atherosclerosis) is a prospective longitudinal study of adults free of cardiovascular disease at baseline. Presence of asthma was determined at exam 1. Persistent asthma was defined as asthma requiring use of controller medications. Intermittent asthma was defined as asthma without use of controller medications. Participants were followed for a median of 12.9 (interquartile range, 10-13.6) years for incident AF. Multivariable Cox regression models were used to assess associations of asthma subtype and AF.
Results:
The 6615 participants were a mean (SD) 62.0 (10.2) years old (47% male, 27% black, 12% Chinese, and 22% Hispanic). AF incidence rates were 0.11 (95% CI, 0.01-0.12) events/10 person-years for nonasthmatics, 0.11 (95% CI, 0.08-0.14) events/10 person-years for intermittent asthmatics, and 0.19 (95% CI, 0.120.49) events/10 person-years for persistent asthmatics (log-rank P=0.008). In risk-factor adjusted models, persistent asthmatics had a greater risk of incident AF (hazard ratio, 1.49 [95% CI, 1.03-2.14], P=0.03). IL (Interleukin)-6 (hazard ratio, 1.26 [95% CI, 1.13-1.42]), TNF (tumor necrosis factor)-α receptor 1 (hazard ratio, 1.09 [95% CI, 1.08-1.11]) and D-dimer (hazard ratio, 1.10 [95% CI, 1.02-1.20]) predicted incident AF, but the relationship between asthma and incident AF was not attenuated by adjustment for any inflammation marker (IL-6, CRP [C-reactive protein], TNF-α R1, D-dimer, and fibrinogen).
Conclusions:
In a large multiethnic cohort with nearly 13 years follow-up, persistent asthma was associated with increased risk for incident AF. This association was not attenuated by adjustment for baseline inflammatory biomarkers.
Insights
Persistent asthma increases the risk of developing atrial fibrillation (AF), even after accounting for inflammation markers. This study highlights a significant link between severe asthma and cardiovascular health.
Area of Science:
- Cardiology
- Pulmonology
- Inflammation Research
Background:
- Asthma and atrial fibrillation (AF) share common inflammatory pathways.
- Persistent asthma, defined by controller medication use, may elevate AF risk.
Purpose of the Study:
- To investigate the association between asthma severity and incident AF.
- To determine if systemic inflammation markers attenuate the asthma-AF relationship.
Main Methods:
- Analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.
- Prospective follow-up for incident AF in adults with and without asthma.
- Multivariable Cox regression models adjusting for risk factors and inflammation markers.
Main Results:
- Persistent asthma was associated with a significantly higher risk of incident AF (HR, 1.49).
- Inflammation markers (IL-6, TNF-α R1, D-dimer) predicted AF.
- The association between persistent asthma and AF was not attenuated by adjustment for inflammation markers.
Conclusions:
- Persistent asthma is linked to an increased risk of developing atrial fibrillation.
- Inflammatory biomarkers do not fully explain the association between persistent asthma and AF.
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