Persistent asthma is associated with an increase in plaque in the arteries leading to the brain

According to a new study published today in the Journal of the American Heart Association, adults with persistent asthma may have an increased risk
of heart attack or stroke due to excessive plaque buildup in the carotid arteries.
Journal of the American Heart Association is an open access, peer-reviewed journal
of the American Heart Association.
People who participated in the study accumulated more plaque
in the carotid arteries (large arteries located on the left and right sides of the neck that carry blood to the brain) than people without asthma.

Asthma is a respiratory condition that causes inflammation of a person's airways – often due to an allergic reaction – making breathing difficult
.
Long-term chronic inflammation is known to lead to plaque buildup in the arteries, known as atherosclerosis, and is associated with
a higher risk of heart disease or stroke from plaque rupture.

"Many doctors and patients don't realize that asthmatic airway inflammation can affect arteries, so addressing risk factors for cardiovascular disease can be really helpful for people with persistent asthma," said Matthew C.
Tattersall, lead author of the study, an assistant professor in the Department of Medicine at the University of Wisconsin, M.
D
.
, M.
S.
"The presence and burden of carotid plaque is a strong predictor
of future cardiovascular events.
"

For this analysis, the researchers used data from participants in the Atherosclerosis Multiethnic Study (MESA) to examine a potential link
between asthma and carotid plaque.
MESA, a study of nearly 7,000 adults that began in 2000, still follows participants in six locations in the United States: Baltimore; Chicago; New York; Los Angeles County, California; Forsyth County, North Carolina; and St.
Paul, Minnesota.

At the time of enrollment, none of the participants in MESA had cardiovascular disease
.

The researchers reviewed health data from 5,029 adults with an average age of 61 who had baseline risk factors for cardiovascular disease and carotid ultrasound data
.
The group of participants was diverse: 26 percent of adults identified themselves as African-American, 23 percent as Hispanic, and 12 percent as Chinese
.
In addition, more than half of the subjects studied (53%) were women
.

Participants in this analysis cohort were categorized as persistent asthma, intermittent asthma, and no asthma
.
The persistent asthma subgroup, defined as daily use of control medications to control asthma symptoms, included 109 participants; A subgroup with intermittent asthma, defined as having a history of asthma but not using daily medications to control asthma symptoms, included 388 participants; The remaining participants did not have asthma
.

At the start of the MESA study, all participants underwent ultrasound of the left and right carotid arteries to determine if carotid plaque
was present.
The total plaque score defines the number of
plaques on the carotid artery wall.
At the beginning of the MESA study, levels
of the inflammatory biomarkers interleukin-6 (IL-6) and c-reactive protein (CRP) in the blood were also measured.

The analysis found:

• Carotid plaque
  is present in 67% of patients with persistent asthma and 49.
  5% of patients with intermittent asthma.
  People with persistent asthma have an average of two carotid plaques, and people with intermittent asthma have an average of one carotid plaque
  .
  

• Among participants without asthma, 50.
  5 percent had carotid plaque, and on average there was about one carotid plaque
  .
  

• After adjusting for age, gender, ethnicity, weight, other health conditions, prescription drug use and smoking, participants with persistent asthma were nearly twice as likely to have carotid plaque as participants without asthma
  .
  

People with persistent asthma had higher
levels of inflammatory biomarkers compared to participants without asthma.
(The average IL-6 for patients with persistent asthma is 1.
89 pg/mL, compared with 1.
52 pg/mL
for patients without asthma.
) The researchers found that considering IL-6 and CRP in a fully adjusted analysis did not reduce the link between
persistent asthma and carotid plaque.

"This analysis tells us that the increased risk of carotid plaque in people with persistent asthma may be influenced by a number of factors
," Tatsar said.
"Participants with persistent asthma had elevated levels of inflammation in their blood, even though their asthma was treated with medication, which highlighted the inflammatory features
of asthma.
" We know that higher levels of inflammation negatively affect the cardiovascular system
.
”

In 2019, the American Heart Association published guidelines for the primary prevention of cardiovascular disease, listing inflammatory diseases such as arthritis and lupus as cardiovascular risk enhancement factors
.
This study adds to the understanding
of the impact of inflammatory diseases on cardiovascular health.

"The most important message in our findings is that more severe asthma is associated with
more cardiovascular disease and cardiovascular events," Tattersall said.
"Addressing cardiovascular risk factors through lifestyle and behavior modifications is a powerful prevention tool
for patients with more severe asthma.
"

Everyone can improve cardiovascular health by following the American Heart Association's Basic Points of Life8: eating healthy foods, exercising, not smoking, getting enough sleep, maintaining a healthy weight, and controlling cholesterol, blood sugar, and blood pressure levels
.
According to the American Heart Association, cardiovascular disease kills more people in the United States each year than all forms of cancer and chronic lower respiratory tract disease combined
.

The main limitation of the study is that it is observational because it is an analysis of the data, so the findings suggest an association between asthma and increased cardiovascular disease risk, rather than a causal relationship
.