ArticlesSymptoms of chronic bronchitis and the risk of coronary disease
Introduction
High serum total-cholesterol, high blood pressure, and smoking are the major risk factors for coronary disease. Obesity, physical inactivity, diabetes, and low high-density-lipoprotein cholesterol also contribute to the risk. Although these factors explain most coronary disease, other factors are also involved. There are various putative risk factors, such as high levels of plasma fibrinogen and other disturbances in blood coagulation, low intake of antioxidants, and psychosocial stress.1
Since early this century case reports and uncontrolled studies have associated infections with the development of coronary disease. More recently, experimental and epidemiological studies have shown a positive association between infections and coronary disease.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 These include infections in different organs, both viral and bacterial and acute and chronic. Most attention has been paid to dental infections and infections in the respiratory tract.7
An influenza-like syndrome resembling acute respiratory infection often precedes myocardial infarction.5, 6 Another respiratory infection often associated with coronary disease is due to Chlamydia pneumoniae.8, 9, 10, 11, 12, 13 C pneumoniae is a common cause of both acute and chronic lung infections.10, 11 In several studies, chronic chlamydia pneumonia was more frequent in patients with myocardial infarction than in controls.7, 8, 11, 13
We have analysed how chronic respiratory infection, defined by the occurrence of symptoms of chronic bronchitis, predicts coronary disease and coronary mortality during a 13-year follow-up among middle-aged men and women. We also analysed potential confounders and whether the risk is similar among different occupations.
Section snippets
Participants and surveys
Risk-factors were surveyed in 1972 and 1977 in the eastern Finnish provinces of North Karelia and Kuopio. A random sample of 6-6% of the population born between 1913 and 1947 was drawn in both areas. In the present analyses the two cohorts were pooled. The total sample was 23 801. Participation rate was 87% among men and 91% among women. Those who participated on both surveys were included only in the first cohort. Of 21 251 responders, 484 were excluded because of a reported history of
Results
Symptoms of chronic bronchitis were more common among smokers than non-smokers (table 1). Among men, only 51% of smokers were free of symptoms, compared with 74% of ex-smokers and 79% of never-smokers. Respective proportions of symptom-free women were 67, 85, and 80%. Among smoking men, the average number of cigarettes smoked daily was 14·7 in subjects without symptoms of chronic bronchitis, 17·4 among those with grade-one symptoms, and 18·6 among those with grade-two symptoms. Among smoking
Discussion
Symptoms of chronic bronchitis predicted the risk of coronary disease independent from the known major cardiovascular risk factors. About one-third in men and one-fifth in women of the excess risk of coronary disease, which associated with the symptoms of chronic bronchitis, was mediated through smoking. Adjustment for the other risk factors, serum cholesterol and blood pressure, had only a minor effect on this association. In our cohorts, the population attributable fraction of coronary
References (30)
- et al.
Cytomegalovirus disease link to coronary artery disease
Am J Cardiol
(1989) - et al.
Association of acute respiratory symptoms with onset of acute myocardial infarction: prospective investigation of 150 consecutive patients and matched control patients
Am J Cardiol
(1984) - et al.
Serological evidence of an association of novel Chlamydia, TWAR, with chronic coronary artery disease and acute myocardial infarction
Lancet
(1988) - et al.
Chlamydia pneumoniae: risk factors for seropositivity and association with coronary artery disease
J Infect
(1995) - et al.
Von Willebrand factor antigen and dental infections
Thromb Res
(1989) - et al.
Changes in serum lipoprotein pattern induced by acute infection
Metabolism
(1988) Cardiovascular diseases risk factors: new areas for research
(1994)- et al.
Infection and inflammation as risk factors for myocardial infarction
Eur Heart J
(1993) - et al.
Relation of Helicobacter pylori infection and coronary heart disease
Br Heart J
(1994) Viral and bacterial infections in acute myocardial infarction
J Intern Med
(1989)
Chronic Chlamydia pneumoniae infection as a risk factor for coronary artery disease in the Helsinki Heart study
Ann Intern Med
Chlamydia pneumoniae strain TWAR antibody and angiographically demonstrated coronary artery disease
Arterioscler Thromb
Chlamydial infections and the heart: a review
Eur J Clin Microbiol Inf Dis
A new respiratory tract pathogen: Chlamydia pneumoniae strain TWAR
J Infect Dis
In vitro susceptibility of human vascular wall cells to infection with Chlamydia pneumoniae
J Clin Microbiol
Cited by (225)
Systemic vascular health is compromised in both confirmed and unconfirmed asthma
2022, Respiratory MedicineCitation Excerpt :However, participants with confirmed asthma reported greater asthma symptoms, had lower baseline FEV1 and greater post-bronchodilator reversibility compared to unconfirmed asthma participants. Previous studies have indicated there may be a direct link between respiratory morbidity and cardiovascular risk [12,13], and reduced endothelial function, elevated arterial stiffness, and systemic inflammation has been associated with worse asthma disease severity and declining control [31,32,33]. Conversely, the lack of differences between unconfirmed and confirmed asthma in our study would indicate that the impaired endothelial function is unlikely due to common causes of respiratory symptoms, reduced lung function, or airway reversibility alone, but rather suggests that other important contributing factors may be present.
Associations between lung function and future cardiovascular morbidity and overall mortality in a predominantly First Nations population: a cohort study.
2021, The Lancet Regional Health - Western PacificThe Wide-Ranging Spectrum of Cough-Induced Complications and Patient Harm
2020, American Journal of MedicineCitation Excerpt :Chronic cough whether productive or dry, was found to be an independent predictor of MI with significant odds ratio of 1.6 or 1.8, respectively.36 Although not followed by other studies, these data strongly confirm a previous study from Finland37 and moreover, risk correlated with increased plasma fibrinogen level, an acute-phase reactant, and could well be explained by chronic cough-associated chronic pulmonary inflammation, an established novel risk factor of atherosclerosis. Another intriguing type of myocardial injury is stress cardiomyopathy (Takotsubo) that was reported after particularly bad bouts of coughing in 2 women.
Bronchiectasis and Chronic Suppurative Lung Disease
2019, Kendig's Disorders of the Respiratory Tract in ChildrenBlue-collar work and women's health: A systematic review of the evidence from 1990 to 2015
2018, SSM - Population HealthCitation Excerpt :Several studies identified chemical exposures a risk factor not only for cancers among blue-collar women (Betenia, Costello, & Eisen, 2012; Oddone et al., 2014; Richiardi et al., 2004; Thompson, Kriebel, Quinn, Wegman, & Eisen, 2005), but also for psychiatric distress and depression (Bromet, Dew, Parkinson, Cohen, & Schwartz, 1992; Parkinson et al., 1990). Increased job demand, job conflict, subjective monotony, skill underutilization and sexual harassment were all identified as risk factors for psychiatric distress (Goldenhar, Swanson, Hurrell, Ruder, & Deddens, 1998; Kivimäki et al., 2007; Melamed, Ben-Avi, Luz, & Green, 1995), although reduced psychological distress was observed among blue-collar women with adequate social support (Bromet et al., 1992; Brunette, Smith, & Punnett, 2011). Factors such as work control, job strain, and occupational stress do not appear to be associated with cardiovascular disease among blue-collar women (Hall, Johnson, & Tsou, 1993; Tsutsumi, Kayaba, & Ishikawa, 2011; Tsutsumi, Kayaba, Tsutsumi, & Igarashi, 2001).