ASTHMA

Asthma and incident cardiovascular disease: the Atherosclerosis Risk in Communities Study

J G Schanen¹, C Iribarren², E Shahar¹, N M Punjabi³, S S Rich⁴, P D Sorlie⁵, A R Folsom¹

¹ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
² Division of Research, Kaiser Permanente, Oakland, CA, USA
³ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
⁴ Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
⁵ Epidemiology and Biometry Program, NHLBI, Bethesda, MD, USA

Correspondence to:
Correspondence to:
Dr A R Folsom
University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454, USA; folsom{at}epi.umn.edu

Background: A possible association between asthma and cardiovascular disease has been described in several exploratory studies.

Methods: The association of self-reported, doctor diagnosed asthma and incident cardiovascular disease was examined in a biracial cohort of 45–64 year old adults (N = 13501) followed over 14 years.

Results: Compared with never having asthma, the multivariate adjusted hazard ratio (HR) of stroke (n = 438) was 1.50 (95% CI 1.04 to 2.15) for a baseline report of ever having asthma (prevalence 5.2%) and 1.55 (95% CI 0.95 to 2.52) for current asthma (prevalence 2.7%). The relative risk of stroke was 1.43 (95% CI 1.03 to 1.98) using a time dependent analysis incorporating follow up reports of asthma. Participants reporting wheeze attacks with shortness of breath also had greater risk for stroke (HR = 1.56, 95% CI 1.18 to 2.06) than participants without these symptoms. The multivariate adjusted relative risk of coronary heart disease (n = 1349) was 0.87 (95% CI 0.66 to 1.14) for ever having asthma, 0.69 (95% CI 0.46 to 1.05) for current asthma at baseline, and 0.88 (95% CI 0.69 to 1.11) using the time dependent analysis.

Conclusions: Asthma may be an independent risk factor for incident stroke but not coronary heart disease in middle aged adults. This finding warrants replication and may motivate a search for possible mechanisms that link asthma and stroke.

Abbreviations: CHD, coronary heart disease; CVD, cardiovascular disease; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; HR, hazards ratio; RR, risk ratio; SMR, standardised mortality ratio

Keywords: asthma; coronary heart disease; stroke

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