Adult Asthma and Risk of Coronary Heart Disease, Cerebrovascular Disease, and Heart Failure: A Prospective Study of 2 Matched Cohorts
American Journal of Epidemiology, (2012), doi: 10.1093/aje/kws181
Carlos Iribarren*, Irina V. Tolstykh, Mary K. Miller, Erica Sobel and Mark D. Eisner
?*Correspondence to Dr. Carlos Iribarren, Division of Research, Kaiser Permanente Medical Care Program, 2000 Broadway, Oakland, CA 94612 (e-mail: cgi at dor.kaiser.org).
Abbreviations: CHD, coronary heart disease; CVD, cardiovascular disease; ICD-9, International Classification of Diseases, Ninth Revision; KPNC, Kaiser Permanente Northern California.
Asthma has been associated with increased cardiovascular disease (CVD) risk. The authors ascertained the association of asthma with CVD and the roles that sex, concurrent allergy, and asthma medications may play in this association. They assembled a cohort of 203,595 Northern California adults with asthma and a parallel asthma-free referent cohort (matched 1:1 on age, sex, and race/ethnicity); both cohorts were followed for incident nonfatal or fatal CVD and all-cause mortality from January 1, 1996, through December 31, 2008.
Each cohort was 66% female and 47% white.
After adjustment for age, sex, race/ethnicity, cardiac risk factors, and comorbid allergy, asthma was associated with a
- 1.40-fold (95% confidence interval (CI): 1.35, 1.45) increased hazard of coronary heart disease, a
- 1.20-fold (95% CI: 1.15, 1.25) hazard of cerebrovascular disease, a
- 2.14-fold (95% CI: 2.06, 2.22) hazard of heart failure, and a
- 3.28-fold (95% CI: 3.15, 3.41) hazard of all-cause mortality.
Stronger associations were noted among women. Comorbid allergy predicted CVD but did not synergistically increase the CVD risk associated with asthma.
Only asthma patients using asthma medications (particularly those on oral corticosteroids alone or in combination) were at enhanced risk of CVD. In conclusion, asthma was prospectively associated with increased risk of major CVD. Modifying effects were noted for sex and asthma medication use but not for comorbid allergy.
Received November 14, 2011, Accepted March 16, 2012, First published online: November 8, 2012
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