Asthma is a heterogeneous syndrome in which presentations can vary significantly between patients.
Although it is not usually recognized as such, there are different clinical subtypes of asthma, each with unique pathophysiology. Specific subtypes may be associated with an increased risk for cardiovascular disease (CVD). “Asthma and CVD may be interconnected, but studies indicating a cause-and-effect relationship between the conditions have been mixed,” says Matthew C. Tattersall, DO, MS.
For a study published in the Journal of the American Heart Association, Dr. Tattersall and colleagues investigated if late‐onset subtype of asthma is associated with a higher risk of incident CVD. “This type of asthma tends to be more severe and more difficult to control with medications than early-onset asthma,” notes Dr. Tattersall. He and his colleagues followed participants from the Wisconsin Sleep Cohort who did not have CVD at baseline and tracked them for an average of nearly 14 years. The analysis involved 1,269 patients aged 47, on average; 111 of these patients had late-onset asthma whereas 55 had early-onset asthma.
“Our study showed that patients with late-onset asthma were nearly 60% more likely than those without asthma to experience a CVD event, such as a heart attack, stroke, heart failure, angina, and/or cardiovascular-related death,” Dr. Tattersall says. Study participants with late‐onset asthma were more likely than those without the disease to be a woman (67% vs 44%) and to have a higher BMI (32.2 kg/m2 vs 29.4 kg/m2). The average age of an asthma diagnosis in the late‐onset group was 39.5 years, compared with 8.9 years for the early‐onset group. However, there appeared to be no interaction between BMI and age of asthma diagnosis on incident CVD.
According to Dr. Tattersall, late-onset asthma is difficult to control and often caused by various other factors. “These patients also commonly experience more rapid declines in lung function,” he says. “Our research was observational by nature, so the findings do not imply a causal relationship. Instead, the results suggest that there may be a common pathway for both asthma and CVD. Clinicians should recognize the overlap of symptoms for these conditions and may need to take more aggressive preventive measures to ensure that patients with late-onset asthma do not develop CVD.”
More research into the causes of the observed association is needed because it may have treatment implications, says Dr. Tattersall. “In the meantime, physicians should closely monitor CVD risk factors, such as blood pressure and cholesterol levels, when managing patients with asthma,” he says. “If these levels are elevated, it’s critical to aggressively address these risk factors with pharmacologic therapies, lifestyle modifications, or both.” The study adds that these patients should also be instructed to help themselves by exercising more, eating a healthy diet, and maintaining a normal body weight.
Matthew C. Tattersall, DO, MS, has indicated to Physician’s Weekly that he has received grants/research aid from the NIH (T32 HL07936).
Readings & Resources (click to view)
Tattersall MC, Barnet JH, Korcarz CE, Hagen EW, Peppard PE, Stein JH. Late-onset asthma predicts cardiovascular disease events: the Wisconsin Sleep Cohort. J Am Heart Assoc. 2016;5:e003448. Available at: http://jaha.ahajournals.org/content/5/9/e003448.abstract.
Tattersall MC, Guo M, Korcarz CE, et al. Asthma predicts cardiovascular disease events: the multi-ethnic study of atherosclerosis. Arterioscler Thromb Vasc Biol. 2015;35:1520-1525.
Schanen JG, Iribarren C, Shahar E, et al. Asthma and incident cardiovascular disease: the Atherosclerosis Risk in Communities Study. Thorax. 2005;60:633-638.
Lee HM, Truong ST, Wong ND. Association of adult-onset asthma with specific cardiovascular conditions. Respir Med. 2012;106:948-953.