Asthma Linked with Incident CVD in Framingham Offspring Cohort Analysis

May 29, 2020

An independent association between asthma and risk of cardiovascular disease remained even after adjusting for other CVD risk factors, authors report.

Asthma is associated with an increased risk of cardiovascular disease (CVD), even after controlling for a range of known CVD risk factors, according to a recent analysis of Framingham Offspring Cohort data. Authors suggest that a shared underlying inflammatory state may help explain the link.

The findings were published online in the edition of the American Journal of Respiratory and Critical Care Medicine dedicated to abstracts from the 2020 International Conference of the American Thoracic Society. The ATS 2020 was to have taken place May 15-20, 2020, in Philadelphia but was cancelled because of the coronavirus pandemic.

Shared etiology

Chronic systemic inflammation, the authors note in the abstract, plays a significant role in the sequence of events that result in poorly controlled asthma and in ischemic or atherosclerotic disease. Asthma has been suggested as a risk factor for CVD, they state, but there is very limited longitudinal evidence for the relationship.

To explore the link, Matias Evaristo Pollevick, a medical student at Northwestern University Feinberg School of Medicine in Chicago, and colleagues used data from the prospective, population-based Framingham Offspring Study. They analyzed data from 3612 individuals aged 17 to 77 years, who took part in examinations from 1979 to 2014. The presence of asthma was based on physician diagnosis during study interviews; incident CVD included myocardial infarction (MI), angina, coronary insufficiency, stroke, transient ischemic attack, or heart failure.

Investigators calculated the unadjusted probability of developing CVD among participants with and without asthma, censoring data at the date of non-CVD-related death or at the date of the last follow-up visit, among participants who were alive and free of CVD in 2014.

Time-dependent Cox regression models were used to evaluate the adjusted relationship between asthma and CVD incidence.

______________________________________________________

A diagnosis of asthma was made in 534 participants (10%), and 897 (25%) developed CVD during the course of the study. Unadjusted analysis revealed that asthma was associated with increased CVD incidence, with a hazard ratio of 1.40 (95% confidence interval [CI] 1.17–1.68).

After adjusting for established CV risk factors, an independent association remained between asthma and CVD incidence, with a hazard ratio of 1.28 (95% CI 1.07–1.54).

______________________________________________________

In their conclusion, the authors state that their findings point to individuals with asthma as “a high-risk group that may benefit from targeted interventions to prevent onset of CVD.” They also note that there is a potential role for “personalized CVD prevention strategies among patients with asthma.”

Pollevick and colleagues call for future research into the pathophysiology of the hyperinflammatory state shared by the 2 conditions.