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Bazan-Socha S, Mastalerz L, Cybulska A, Zareba L, Jakiela B, Zabczyk M, Iwaniec T, Undas A. Factor VIIa-Antithrombin Complexes are Increased in Asthma: Relation to the Exacerbation-Prone Asthma Phenotype. Thromb Haemost 2025. [PMID: 39805288 DOI: 10.1055/a-2515-1402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2025]
Abstract
BACKGROUND Asthma is associated with a prothrombotic state. Plasma factor VIIa-antithrombin complex (FVIIa-AT) concentrations indirectly reflect the interaction of tissue factor (TF) with FVII. Since TF is a key initiator of coagulation in vivo, we hypothesized that FVIIa-AT concentrations are higher in asthma. METHODS In 159 clinically stable adult asthma patients and 62 controls, we determined FVIIa-AT in plasma and analyzed their relation to circulating inflammatory and prothrombotic markers together with the total plasma potential for fibrinolysis (clot lysis time, CLT) and thrombin generation. We recorded clinical outcomes, including asthma exacerbations, during 3-year follow-up. RESULTS Asthma patients were characterized by 38.5% higher FVIIa-AT (p < 0.001), related to bronchial obstruction (FEV1: r = -0.397, p < 0.001), asthma severity (r = 0.221, p = 0.005), and duration (r = 0.194, p = 0.015) compared to controls. FVIIa-AT showed weak positive associations with C-reactive protein (r = 0.208, p = 0.009), fibrinogen (r = 0.215, p = 0.007), and CLT (r = 0.303, p < 0.001) but not with thrombin generation parameters. In the follow-up (data obtained from 151 patients), we documented 151 severe asthma exacerbations in 51 (33.8%) patients, including 33 (21.9%) with ≥2 such events. Exacerbation-prone asthma phenotype was related to 13.1% higher FVIIa-AT (p = 0.012), along with asthma severity and control (p < 0.003, both). High FVIIa-AT (that is ≥100.1 pmol/L), defined on receiver operating characteristic curves, was linked to exacerbation-prone asthma phenotype (odds ratio 1.85; 95%CI: 1.23-2.80, p = 0.003) and shorter time to first exacerbation (p = 0.023). CONCLUSION This study is the first to show that FVIIa-AT concentrations are higher in asthma in relation to its severity and may help identify individuals at risk of the exacerbation-prone asthma phenotype.
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Affiliation(s)
- Stanislawa Bazan-Socha
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Lucyna Mastalerz
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Cybulska
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Lech Zareba
- College of Natural Sciences, Institute of Computer Science, University of Rzeszow, Rzeszów, Poland
| | - Bogdan Jakiela
- Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Michal Zabczyk
- Department of Thromboembolic Diseases, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Teresa Iwaniec
- Department of Hematology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Anetta Undas
- Department of Thromboembolic Diseases, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Centre for Medical Research and Technologies, The St. John Paul II Hospital, Krakow, Poland
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Jiang Y, Huang X, Yu D, Xu C, Wang Y, Wang X, Shen Y. Asthma and the risk of cardiovascular diseases and mortality: a meta-analysis of cohort studies. Ther Adv Respir Dis 2025; 19:17534666251333965. [PMID: 40272211 PMCID: PMC12035221 DOI: 10.1177/17534666251333965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Accepted: 03/25/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND It has been shown that asthma is potentially linked to a higher risk of cardiovascular disease (CVD) and cardiovascular mortality (CVM). OBJECTIVES This study aims to systematically review and summarize epidemiological evidence on the relationship between asthma and these cardiovascular outcomes. DESIGN Systematic review and meta-analysis. DATA SOURCES AND METHODS This meta-analysis, registered with PROSPERO (CRD 42024576126), utilized data from PubMed, Embase, the Cochrane Library, and references from included studies. The search covered literature from the inception of these databases until July 17, 2024. We included observational studies examining the link between asthma and CVD and CVM. Bias risk was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS). We calculated pooled relative risk (RR) with a 95% confidence interval (CI) using a random-effects model. RESULTS A total of 29 studies encompassing 11,380,027 participants were included. The overall risk for CVD in asthma patients was 1.30 (95% CI: 1.20-1.42). Specific CVD risks were elevated for coronary heart disease (CHD, RR 1.35; 95% CI: 1.27-1.42), angina pectoris (AP, RR 1.48; 95% CI: 1.16-1.89), myocardial infarction (MI, RR 1.33; 95% CI: 1.25-1.41), and heart failure (HF, RR 1.53; 95% CI: 1.04-2.23). Asthma was also associated with a higher risk of CVM (RR 1.26; 95% CI: 1.05-1.51). CONCLUSION Asthma is associated with a higher risk of developing CVD, including specific types such as CHD, AP, MI, and HF. In addition, asthma patients face an increased risk of cardiovascular mortality compared to non-asthmatics.
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Affiliation(s)
- Yuyue Jiang
- Department of Respiratory, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Xuqing Huang
- Department of Respiratory, Affiliated Hospital of Hangzhou Normal University, No. 126 Wenzhou Road, Gongshu District, Hangzhou, Zhejiang 310000, China
| | - Dongwei Yu
- Department of Respiratory, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Changqing Xu
- Department of Respiratory, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yan Wang
- Department of Respiratory, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Xi Wang
- Department of Respiratory, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yuezhong Shen
- Department of Respiratory, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
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Campos-Rodríguez F, Chiner E, de la Rosa-Carrillo D, García-Cosío B, Hernádez-Hernández JR, Jiménez D, Méndez R, Molina-Molina M, Soto-Campos JG, Vaquero JM, Gonzalez-Barcala FJ. Respiratory Pathology and Cardiovascular Diseases: A Scoping Review. OPEN RESPIRATORY ARCHIVES 2025; 7:100392. [PMID: 39758960 PMCID: PMC11696865 DOI: 10.1016/j.opresp.2024.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Accepted: 11/12/2024] [Indexed: 01/07/2025] Open
Abstract
Respiratory diseases and cardiovascular diseases (CVDs) have high prevalence and share common risk factors. In some respiratory diseases such as sleep apnoea and COPD, the evidence of their negative impact on the prognosis of CVDs seems clear. However, in other diseases it is less evident whether there is any direct relationship. With this in mind, our objective was to provide information that may be helpful to better understand the relationship between respiratory pathology and CVDs. There are different reasons for this relationship, such as shared risk factors, common pathophysiological mechanisms, side effects of treatment and the direct effect in the heart and great vessels of respiratory diseases. Indeed, aging and smoking are risk factors for CVDs and also for respiratory diseases such as obstructive sleep apnea (OSA), COPD and interstitial lung diseases (ILD). Furthermore, there are common pathophysiological mechanisms that affect both respiratory diseases and CVDs, such as accelerated atherosclerosis, microvascular dysfunction, endothelial dysfunction, inflammation, hypoxemia and oxidative stress. Besides that, it is well known that lung cancer, sarcoidosis and amyloidosis may directly affect the heart and great vessels. Finally, side effects of drugs for respiratory diseases and the discontinuation of treatments that are necessary for CVDs, such as β-blockers and aspirin, may have a deleterious impact on the cardiovascular system. In conclusion, the coexistence of respiratory diseases and CVDs is very common. It makes modifying diagnostic and therapeutic management necessary and is also a relevant prognostic factor.
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Affiliation(s)
- Francisco Campos-Rodríguez
- Respiratory Department, Hospital Universitario de Valme, Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Eusebi Chiner
- Respiratory Department, Hospital Universitario of San Juan of Alicante, Alicante, Spain
| | | | - Borja García-Cosío
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, Hospital Son Espases-IdISBa, Palma de Mallorca, Spain
| | | | - David Jiménez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Medicine Department, University of Alcalá, Madrid, Spain
| | - Raúl Méndez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Respiratory Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - María Molina-Molina
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Interstitial Lung Disease (ILD) Unit, Respiratory Department, University Hospital of Bellvitge, IDIBELL, UB, Barcelona, Spain
| | | | - José-Manuel Vaquero
- Department of Pulmonary Medicine and Lung Transplantation, University Hospital Reina Sofia, Avenida Menendez Pidal s/n, 14004 Cordoba, Spain
| | - Francisco-Javier Gonzalez-Barcala
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Translational Research In Airway Diseases Group (TRIAD), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Respiratory Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
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Granda P, Villamañán E, Laorden D, Carpio C, Collada V, Domínguez-Ortega J, de las Vecillas L, Romero-Ribate D, Chaparro-Díaz OF, Lázaro Miguel-Sin T, Alloca-Álvarez DJ, Correa-Borit JM, Losantos I, Mir-Ihara P, Narváez-Fernández EJ, Quirce S, Álvarez-Sala R. Cardiovascular Events in Patients with Severe Asthma-A Retrospective Study of Two Cohorts: Asthma Type T2 Treated with Biologics and Non-Type T2. J Clin Med 2024; 13:4299. [PMID: 39124568 PMCID: PMC11313306 DOI: 10.3390/jcm13154299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 08/12/2024] Open
Abstract
Background: The prevalence of cardiovascular events (CVEs) in patients with asthma varies amongst studies, with little evidence as to their prevalence in patients treated with monoclonal antibodies (mAbs). In this retrospective, observational study, we aimed to evaluate the prevalence of CVEs in patients with T2 and non-T2 asthma and to identify risk factors associated with CVEs. Methods: A total of 206 patients with severe asthma were included. Demographic variables, respiratory comorbidities and cardiovascular risk factors were collected, along with respiratory function, laboratory parameters and respiratory pharmacotherapy, including treatment with mAbs. Results: A total of 10.7% of the patients had any CVE from the date of asthma diagnosis, with a higher risk in those patients with chronic obstructive pulmonary disease (odds ratio [OR] = 5.36, 95% CI 1.76-16.31; p = 0.003), arterial hypertension (OR = 2.71, 95% CI 1.13-6.55; p = 0.026) and dyslipidaemia (OR = 9.34, 95% CI 3.57-24.44; p < 0.001). No association between mAb treatment and a CVE or between time of mAb treatment and the event was found. No significant differences were observed between the T2 and non-T2 cohort. After a multivariate analysis, dyslipidaemia was identified as an independent risk factor (OR = 13.33, 95% CI 4.49-39.58; p < 0.001), whereas regular use of inhaled corticosteroids was associated with a reduced risk of a CVE (OR = 0.103, 95% CI 0.021-0.499; p = 0.005). Further research is needed to fully understand the relationship between severe asthma and CVEs. Conclusions: This study suggests that patients with severe asthma experience a higher percentage of CVEs compared with the general population.
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Affiliation(s)
- Paula Granda
- Pharmacy Department, Gómez Ulla Military Hospital, 28047 Madrid, Spain
| | - Elena Villamañán
- Pharmacy Department, La Paz University Hospital, IdiPAZ, 28029 Madrid, Spain; (E.V.); (V.C.)
- Medicine Department, Autonomous University of Madrid, 28049 Madrid, Spain; (C.C.); (R.Á.-S.)
| | - Daniel Laorden
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Carlos Carpio
- Medicine Department, Autonomous University of Madrid, 28049 Madrid, Spain; (C.C.); (R.Á.-S.)
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Victoria Collada
- Pharmacy Department, La Paz University Hospital, IdiPAZ, 28029 Madrid, Spain; (E.V.); (V.C.)
| | - Javier Domínguez-Ortega
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - Leticia de las Vecillas
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - David Romero-Ribate
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Omar Fabián Chaparro-Díaz
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Teresa Lázaro Miguel-Sin
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Daniela Jose Alloca-Álvarez
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
| | - Jorge Mauricio Correa-Borit
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - Itsaso Losantos
- Biostatistics Department, La Paz University Hospital, 28046 Madrid, Spain;
| | - Patricia Mir-Ihara
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - Emilio José Narváez-Fernández
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - Santiago Quirce
- Allergy Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (J.D.-O.); (L.d.l.V.); (J.M.C.-B.); (P.M.-I.); (E.J.N.-F.); (S.Q.)
| | - Rodolfo Álvarez-Sala
- Medicine Department, Autonomous University of Madrid, 28049 Madrid, Spain; (C.C.); (R.Á.-S.)
- Pneumology Department, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain; (D.L.); (D.R.-R.); (O.F.C.-D.); (T.L.M.-S.); (D.J.A.-Á.)
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Lu J, Wang Z. Mendelian randomisation supports no evidence of the association between asthma and coronary heart disease in East Asians. Eur Respir J 2024; 64:2400628. [PMID: 39054043 DOI: 10.1183/13993003.00628-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/30/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Jiawen Lu
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Zhenqian Wang
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Morgan C, Higbee D. An attack of asthma is not an attack of the heart: clarifying causal links between asthma and incident coronary heart disease. Eur Respir J 2023; 62:2302009. [PMID: 38035696 DOI: 10.1183/13993003.02009-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Caitlin Morgan
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Daniel Higbee
- Academic Respiratory Unit, Southmead Hospital, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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Valencia-Hernández CA, Del Greco M F, Sundaram V, Portas L, Minelli C, Bloom CI. Asthma and incident coronary heart disease: an observational and Mendelian randomisation study. Eur Respir J 2023; 62:2301788. [PMID: 37945032 PMCID: PMC10695770 DOI: 10.1183/13993003.01788-2023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Observational studies suggest asthma is a risk factor for coronary heart disease (CHD) and sex modifies the risk, but they may suffer from methodological limitations. To overcome these, we applied a "triangulation approach", where different methodologies, with different potential biases, were leveraged to enhance confidence in findings. METHODS First, we conducted an observational study using UK medical records to match asthma patients 1:1, by age, sex and general practitioner (GP) practice, to the general population. We measured the association between asthma and incident CHD (myocardial infarction: hospitalisation/death) by applying minimal sufficient adjustment: model 1, smoking, body mass index, oral corticosteroids, atopy and deprivation; model 2, additionally adjusting for healthcare behaviour (GP consultation frequency). Second, we conducted a Mendelian randomisation (MR) study using data from the UK Biobank, Trans-National Asthma Genetic Consortium (TAGC) and Coronary Artery Disease Genome-wide Replication and Meta-analysis consortium (CARDIoGRAM). Using 64 asthma single nucleotide polymorphisms, the effect of asthma on CHD was estimated with inverse variance-weighted meta-analysis and methods that adjust for pleiotropy. RESULTS In our observational study (n=1 522 910), we found asthma was associated with 6% increased risk of CHD (model 1: HR 1.06, 95% CI 1.01-1.13); after accounting for healthcare behaviour, we found no association (model 2: HR 0.99, 95% CI 0.94-1.05). Asthma severity did not modify the association, but sex did (females: HR 1.11, 95% CI 1.01-1.21; males: HR 0.91, 95% CI 0.84-0.98). Our MR study (n=589 875) found no association between asthma and CHD (OR 1.01, 95% CI 0.98-1.04) and no modification by sex. CONCLUSIONS Our findings suggest that asthma is not a risk factor for CHD. Previous studies may have suffered from detection bias or residual confounding.
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Affiliation(s)
| | | | - Varun Sundaram
- Louis Stokes Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Laura Portas
- National Heart and Lung Institute, Imperial College London, London, UK
- Oxford Big Data Institute, University of Oxford, Oxford, UK
| | - Cosetta Minelli
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Chloe I Bloom
- National Heart and Lung Institute, Imperial College London, London, UK
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Mattila T, Vasankari T, Kauppi P, Mazur W, Härkänen T, Heliövaara M. Mortality of asthma, COPD, and asthma-COPD overlap during an 18-year follow up. Respir Med 2023; 207:107112. [PMID: 36596385 DOI: 10.1016/j.rmed.2022.107112] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/19/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND We studied asthma, COPD, and asthma-COPD overlap (ACO) to predict mortality in a cohort of Finnish adults with an 18-year follow up. METHODS A national health examination survey representing Finnish adults aged ≥30 years was performed in 2000-2001. The study cohort included 5922 participants (73.8% of the sample) with all relevant data, including a comprehensive clinical examination and spirometry. These participants were followed continuously from baseline until end of 2018 for total, cardiovascular, cancer, and respiratory mortality through a record linkage. Asthma, COPD, and ACO were defined based on the survey data, including spirometry and register data. There were three separate groups of obstructive subjects (one definition excluding the others). RESULTS Asthma and COPD were significantly associated with higher total mortality in Cox's model adjusted for sex, age, smoking, education level, BMI, leisure time physical activity, cardiovascular disease, diabetes, and hypertension. Hazard ratios (HR) (95% confidence interval [CI]) for asthma, COPD, and ACO were 1.29 (1.05-1.58), 1.50 (1.20-1.88), and 1.26 (0.97-1.65), respectively. Additionally, asthma (HR 1.47, 95% CI 1.09-1.97) and COPD (HR 1.53, 95% CI 1.08-2.16) were associated with cardiovascular mortality. Although ACO did not predict mortality in the whole cohort, there was a significant association with mortality risk among those with hs-CRP 1-2.99 mg/l. CONCLUSIONS Asthma or COPD predicts higher total mortality and premature death from cardiovascular diseases.
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Affiliation(s)
- Tiina Mattila
- Department of Pulmonary Diseases, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Meilahti Triangle Hospital, 6th Floor, PO Box 372, 00029 HUS, Helsinki, Finland; National Institute for Health and Welfare, PO Box 30, 00271, Helsinki, Finland.
| | - Tuula Vasankari
- University of Turku, Division of Medicine, Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital and University of Turku, PO Box 52 (Hämeentie 11), 20521, Turku, Finland; Finnish Lung Health Association (FILHA), Filha ry, Sibeliuksenkatu 11 A 1, 00250, Helsinki, Finland
| | - Paula Kauppi
- Department of Pulmonary Diseases, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Meilahti Triangle Hospital, 6th Floor, PO Box 372, 00029 HUS, Helsinki, Finland
| | - Witold Mazur
- Department of Pulmonary Diseases, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Meilahti Triangle Hospital, 6th Floor, PO Box 372, 00029 HUS, Helsinki, Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare, PO Box 30, 00271, Helsinki, Finland
| | - Markku Heliövaara
- National Institute for Health and Welfare, PO Box 30, 00271, Helsinki, Finland
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Zhang B, Li ZF, An ZY, Zhang L, Wang JY, Hao MD, Jin YJ, Li D, Song AJ, Ren Q, Chen WB. Association Between Asthma and All-Cause Mortality and Cardiovascular Disease Morbidity and Mortality: A Meta-Analysis of Cohort Studies. Front Cardiovasc Med 2022; 9:861798. [PMID: 35369308 PMCID: PMC8968068 DOI: 10.3389/fcvm.2022.861798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAsthma and cardiovascular disease (CVD) share many risk factors. Previous meta-analyses indicated that asthma is associated with an increased risk of CVD and all-cause mortality, but these studies were limited by unstandardized search strategies and the number of articles included.ObjectiveWe sought to systematically synthesize evidence investigating the impact of asthma on all-cause mortality and CVD morbidity and mortality.MethodsWe searched in PubMed and EMBASE for observational cohort studies (inception dates to November 10, 2021) that had both asthma groups and control groups. We also manually searched the reference lists of correlative articles to include other eligible studies. Data for associations between asthma and all-cause mortality and CVD morbidity and mortality were needed.ResultsWe summarized the findings from 30 cohort studies comprising 4,157,823 participants. Asthma patients had increased CVD morbidity [relative risk (RR) = 1.28, 95% confidence interval (CI) = 1.16–1.40] and increased CVD mortality (RR = 1.25, 95% CI = 1.14–1.38). Asthma patients also had increased risk of all-cause mortality (RR = 1.38, 95% CI = 1.07–1.77). In subgroup analyses, female asthma patients had a higher risk of CVD morbidity and all-cause mortality than male asthma patients, and late-onset asthma patients had a higher risk of CVD morbidity than early-onset asthma patients.ConclusionAsthma patients have increased risk of all-cause mortality and CVD morbidity and mortality. This information reminds clinicians to be aware of the risk of CVD and all-cause mortality in asthma patients.Systematic Review Registrationhttp://www.crd.york.ac.uk/PROSPERO/, PROSPERO, identifier: CRD 42021290082.
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Affiliation(s)
- Bin Zhang
- Department of Cardiovascular Disease and Clinical Experimental Center, Jiangmen Central Hospital, Jiangmen, China
| | - Zhi-Fei Li
- Aerospace Center Hospital, Beijing, China
| | - Zhuo-Yu An
- Peking University People's Hospital, Beijing, China
| | - Li Zhang
- Aerospace Center Hospital, Beijing, China
| | | | | | - Yi-Jing Jin
- Peking University First Hospital, Beijing, China
| | - Dong Li
- Department of Intensive Care Unit and Clinical Experimental Center, Jiangmen Central Hospital, Jiangmen, China
| | - An-Jian Song
- Department of Cardiovascular Disease and Clinical Experimental Center, Jiangmen Central Hospital, Jiangmen, China
| | - Qiang Ren
- Department of Cardiovascular Disease and Clinical Experimental Center, Jiangmen Central Hospital, Jiangmen, China
| | - Wen-Biao Chen
- Department of Respiratory Medicine, People's Hospital of Longhua, The Affiliated Hospital of Southern Medical University, Shenzhen, China
- *Correspondence: Wen-Biao Chen
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Winder B, Kiechl SJ, Gruber NM, Bernar B, Gande N, Staudt A, Stock K, Hochmayr C, Geiger R, Griesmacher A, Anliker M, Kiechl S, Kiechl-Kohlendorfer U, Knoflach M. The association of allergic asthma and carotid intima-media thickness in adolescence: data of the prospective early vascular ageing (EVA)-Tyrol cohort study. BMC Cardiovasc Disord 2022; 22:11. [PMID: 35042472 PMCID: PMC8764773 DOI: 10.1186/s12872-021-02452-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In recent years, there has been increasing evidence that asthma is associated with atherosclerosis and cardiovascular disease. However, data in children and adolescents are scarce and conflicting. We aimed to assess the impact of asthma with and without an allergic component on the carotid intima-media thickness in a large pediatric population. METHODS The community-based early vascular ageing-Tyrol cohort study was performed between May 2015 and July 2018 in North, East (Austria) and South Tyrol (Italy) and recruited youngster aged 14 years and above. Medical examinations included anthropometric measurements, fasting blood analysis, measurement of the carotid intima-media thickness by high-resolution ultrasound, and a physician guided interview. RESULTS The mean age of the 1506 participants was 17.8 years (standard deviation 0.90). 851 (56.5%) participants were female. 22 subjects had a physician diagnosis of non-allergic asthma, 268 had inhalative allergies confirmed by a positive radio-allergo-sorbent-test and/or prick test, and 58 had allergic asthma. Compared to healthy controls, participants with non-allergic asthma (411.7 vs. 411.7 µm; p = 0.932) or inhalative allergy (420.0 vs. 411.7 µm; p = 0.118) did not have significantly higher carotid intima-media thickness (cIMT). However, participants with allergic asthma had significantly higher cIMT (430.8 vs. 411.7; p = 0.004) compared to those without and this association remained significant after multivariable adjustment for established cardiovascular risk factors. CONCLUSION Allergic asthma in the youth is associated with an increased carotid intima-media thickness. Physicians should therefore be aware of allergic asthma as a potential cardiovascular risk factor in children and adolescents. Trial Registration Number The EVA-Tyrol Study has been retrospectively registered at clinicaltrials.gov under NCT03929692 since April 29, 2019.
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Affiliation(s)
- Bernhard Winder
- Department of Pediatrics II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
- VASCage, Research Centre on Vascular Ageing and Stroke, Innrain 66a, 6020, Innsbruck, Austria
| | - Sophia J Kiechl
- VASCage, Research Centre on Vascular Ageing and Stroke, Innrain 66a, 6020, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Nadja M Gruber
- VASCage, Research Centre on Vascular Ageing and Stroke, Innrain 66a, 6020, Innsbruck, Austria
| | - Benoît Bernar
- Department of Pediatrics II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
- Department of Pediatrics I, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Nina Gande
- Department of Pediatrics II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Anna Staudt
- Department of Pediatrics II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Katharina Stock
- Department of Pediatrics II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
- Department of Pediatrics III, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Christoph Hochmayr
- Department of Pediatrics II, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Ralf Geiger
- Department of Pediatrics III, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Institute of Clinical Chemistry and Laboratory Medicine (ZIMCL), Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Markus Anliker
- Central Institute of Clinical Chemistry and Laboratory Medicine (ZIMCL), Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Stefan Kiechl
- VASCage, Research Centre on Vascular Ageing and Stroke, Innrain 66a, 6020, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | | | - Michael Knoflach
- VASCage, Research Centre on Vascular Ageing and Stroke, Innrain 66a, 6020, Innsbruck, Austria.
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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11
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Strauss MJ, Niederkrotenthaler T, Thurner S, Kautzky-Willer A, Klimek P. Data-driven identification of complex disease phenotypes. J R Soc Interface 2021; 18:20201040. [PMID: 34314651 PMCID: PMC8315834 DOI: 10.1098/rsif.2020.1040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Disease interaction in multimorbid patients is relevant to treatment and prognosis, yet poorly understood. In the present work, we combine approaches from network science, machine learning and computational phenotyping to assess interactions between two or more diseases in a transparent way across the full diagnostic spectrum. We demonstrate that health states of hospitalized patients can be better characterized by including higher-order features capturing interactions between more than two diseases. We identify a meaningful set of higher-order diagnosis features that account for synergistic disease interactions in a population-wide (N = 9 M) medical claims dataset. We construct a generalized disease network where (higher-order) diagnosis features are linked if they predict similar diagnoses across the whole diagnostic spectrum. The fact that specific diagnoses are generally represented multiple times in the network allows for the identification of putatively different disease phenotypes that may reflect different disease aetiologies. At the example of obesity, we demonstrate the purely data-driven detection of two complex phenotypes of obesity. As indicated by a matched comparison between patients having these phenotypes, we show that these phenotypes show specific characteristics of what has been controversially discussed in the medical literature as metabolically healthy and unhealthy obesity, respectively. The findings also suggest that metabolically healthy patients show some progression towards more unhealthy obesity over time, a finding that is consistent with longitudinal studies indicating a transient nature of metabolically healthy obesity. The disease network is available for exploration at https://disease.network/.
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Affiliation(s)
- Markus J Strauss
- Complexity Science Hub Vienna, Josefstädter Straße 39, 1080 Wien, Austria
| | - Thomas Niederkrotenthaler
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090 Wien, Austria
| | - Stefan Thurner
- Complexity Science Hub Vienna, Josefstädter Straße 39, 1080 Wien, Austria.,Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, 1090 Wien, Austria.,Santa Fe Institute, 1399 Hyde Park Road, Santa Fe, NM 85701, USA
| | - Alexandra Kautzky-Willer
- Department of Endocrinology and Metabolism, Internal Medicine III, Medical University of Vienna, Spitalgasse 23, 1090 Wien, Austria
| | - Peter Klimek
- Complexity Science Hub Vienna, Josefstädter Straße 39, 1080 Wien, Austria.,Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, 1090 Wien, Austria
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12
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Adults with current asthma but not former asthma have higher all-cause and cardiovascular mortality: a population-based prospective cohort study. Sci Rep 2021; 11:1329. [PMID: 33446724 PMCID: PMC7809422 DOI: 10.1038/s41598-020-79264-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/24/2020] [Indexed: 12/02/2022] Open
Abstract
Higher mortality in asthmatics has been shown previously. However, evidence on different asthma phenotypes on long-term mortality risk is limited. The aim was to evaluate the impact of asthma phenotypes on mortality in general population. Data from the National Health and Nutrition Examination Survey from 2001–2002 to 2013–2014 linked mortality files through December 31, 2015, were used (N = 37,015). Cox proportional hazards regression was used to estimate the risk of all-cause and cause-specific mortality adjusting for sociodemographic characteristics, smoking, body mass index, and chronic conditions. During the mean follow-up time of 7.5 years, 4326 participants died from a variety of causes. Current asthma, but not former asthma was associated with increased all-cause mortality (current asthma: HR = 1.37; 95% CI 1.20–1.58; Former asthma: HR = 0.93; 95% CI 0.73–1.18); as well as mortality from cardiovascular disease (HRCurrent = 1.41; 95% CI 1.08–1.85) and chronic lower respiratory diseases (HRCurrent = 3.17; 95% CI 1.96–5.14). In addition, we found that the HR for cardiovascular disease (CVD) mortality was slightly greater in people with childhood-onset asthma than those with adult-onset asthma. The HR for chronic lower respiratory diseases (CLRD) mortality was greater in people with adult-onset asthma than those with childhood-onset asthma. However, the differences were not statistically significant. Our study suggested that current asthma but not former asthma was associated with increased all-cause, CLRD and CVD mortality. Future well-designed studies with larger sample are required to demonstrate the association and clarify the potential mechanisms involved.
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13
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Di Raimondo D, Musiari G, Benfante A, Battaglia S, Rizzo G, Tuttolomondo A, Scichilone N, Pinto A. Prevalence of Arterial Hypertension and Characteristics of Nocturnal Blood Pressure Profile of Asthma Patients According to Therapy and Severity of the Disease: The BADA Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:6925. [PMID: 32971927 PMCID: PMC7557609 DOI: 10.3390/ijerph17186925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND several studies report an increased risk for asthmatic subjects to develop arterial hypertension and the relationship between these two diseases, frequently co-existing, still has some unclear aspects. METHODS The BADA (blood pressure levels, clinical features and markers of subclinical cardiovascular damage of asthma patients) study is aimed to evaluate the prevalence of the cardiovascular comorbidities of asthma and their impact on the clinical outcome. The main exclusion criteria were the presence of other respiratory diseases, current smoking, any contraindication to ambulatory blood pressure monitoring (ABPM). RESULTS The overall percentage of asthmatics having also hypertension was 75% (30 patients) vs. 45% (18 patients) of the control group (p: 0.012). Reduced level of FEV1 (but not inhaled steroid therapy) was associated to newly-diagnosed hypertension (p: 0.0002), higher day SBP levels (p: 0.003), higher day DBP levels (p: 0.03), higher 24 h-SBP levels (p: 0.005) and higher 24h-DBP levels (p: 0.03). The regression analysis performed taking into account sex, age, diabetes, fasting glucose, and body mass index confirms the independent role played by asthma: odds ratio (OR): 3.66 (CI: 1.29-11.1). CONCLUSIONS hypertension is highly prevalent in asthma; the use of ABPM has allowed the detection of a considerable number of unrecognized hypertensives.
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Affiliation(s)
- Domenico Di Raimondo
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90133 Palermo, Italy; (G.M.); (G.R.); (A.T.); (A.P.)
| | - Gaia Musiari
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90133 Palermo, Italy; (G.M.); (G.R.); (A.T.); (A.P.)
| | - Alida Benfante
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90133 Palermo, Italy; (A.B.); (S.B.); (N.S.)
| | - Salvatore Battaglia
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90133 Palermo, Italy; (A.B.); (S.B.); (N.S.)
| | - Giuliana Rizzo
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90133 Palermo, Italy; (G.M.); (G.R.); (A.T.); (A.P.)
| | - Antonino Tuttolomondo
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90133 Palermo, Italy; (G.M.); (G.R.); (A.T.); (A.P.)
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90133 Palermo, Italy; (A.B.); (S.B.); (N.S.)
| | - Antonio Pinto
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (Promise) G. D’Alessandro, University of Palermo, 90133 Palermo, Italy; (G.M.); (G.R.); (A.T.); (A.P.)
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14
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Chung WS, Kung PT, Chang HY, Tsai WC. Demographics and medical disorders associated with smoking: a population-based study. BMC Public Health 2020; 20:702. [PMID: 32414354 PMCID: PMC7227312 DOI: 10.1186/s12889-020-08858-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/06/2020] [Indexed: 01/08/2023] Open
Abstract
Background Few studies have investigated factors associated with smoking behaviors. In this population-based study, we investigated demographics and medical comorbid diseases to establish a prediction model for smoking behaviors by using the National Health Interview Survey (NHIS) and National Health Insurance Research Database (NHIRD). Methods We enrolled individuals aged ≥40 years who had participated in the NHIS in 2001, 2005, and 2009. We identified the smoking behaviors of the study participants in the NHIS. Smoking behaviors were divided into ever smokers (current smokers and ex-smokers) and nonsmokers (never smokers).We defined medical comorbid disorders of the study participants by using medical claim data from the NHIRD. We used multivariable logistic regression models to calculate the adjusted odds ratio and 95% confidence interval for variables associated with smoking. The significant variables in the multivariable model were included in the receiver operating characteristic curves (ROC) to predict the sensitivity and specificity of the model. Results In total, 26,375 participants (12,779 men and 13,596 women) were included in the analysis. The prevalence of smoking was 39.29%. The mean ages of the 16,012 nonsmokers were higher than those of the 10,363 smokers (57.86 ± 12.92 years vs. 53.59 ± 10.82 years). Men outnumbered women among smokers (68.18% vs. 31.82%). Male sex, young age and middle age, being insured categories, residence in suburban areas, and chronic obstructive pulmonary disease (COPD) were independent factors associated with smoking. The area under the ROC curve of these significant factors to predict smoking behaviors was 71.63%. Conclusion Sex, age, insured categories, residence in suburban areas, and COPD were associated with smoking in people.
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Affiliation(s)
- Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan.,Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road,, Taichung, 40402, Taiwan.,Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Hui-Yun Chang
- Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road,, Taichung, 40402, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road,, Taichung, 40402, Taiwan.
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15
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Increased activity of lipoprotein-associated phospholipase A 2 in non-severe asthma. Allergol Int 2019; 68:450-455. [PMID: 31064688 DOI: 10.1016/j.alit.2019.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/19/2019] [Accepted: 04/03/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Given increased risk of cardiovascular events in asthma we hypothesized that lipoprotein-associated phospholipase A2 (Lp-PLA2), an enzyme involved in atherosclerosis, is associated with proinflammatory and prothrombotic blood alterations in this disease. METHODS In 164 adult asthmatics (63 with severe asthma) we measured plasma Lp-PLA2 activity using the PLAC test. We determined its relations to inflammation and prothrombotic blood alterations. RESULTS In asthma, Lp-PLA2 was inversely related to the age (β = -0.1 [-0.18 to -0.02]) and was lower in women (n = 122 [74%], 205 [182-242] vs. 243 [203-262] nmol/min/ml, p = 0.001). Interestingly, Lp-PLA2 correlated negatively with the asthma severity score (β = -0.15 [-0.23 to -0.07]), being 10.3% higher in those with non-severe (mild or moderate) asthma (n = 101, 62%) as compared to the severe disease subtype (224 [191-261] vs. 203 [181-229], p = 0.006 after adjustment for potential confounders). Lp-PLA2 activity was positively related to the levels of low-density lipoprotein (β = 0.1 [0.02-0.18]), triglycerides (β = 0.11 [0.03-0.19]) and glucose (β = 0.1 [0.02-0.18]) and inversely to the tumor necrosis factor α (β = -0.27 [-0.35 to -0.2]), high sensitivity C-reactive protein (β = -0.1 [-0.19 to -0.02]) and fibrinogen (β = -0.12 [-0.21 to -0.03]), as well as prothrombin (β = -0.16 [-0.24 to -0.08]), and parameters describing thrombin generation potential, such as endogenous thrombin potential (β = -0.14 [-0.21 to -0.06]) and peak thrombin generated (β = -0.2 [-0.28 to -0.12]). CONCLUSIONS Elevated Lp-PLA2 activity in non-severe asthmatics suggests increased atherosclerotic risk in this group. Lower Lp-PLA2 activity accompanied by its inverse relationship to inflammatory or prothrombotic blood biomarkers observed in turn in severe asthmatics might be related to the pathogenesis of more severe asthma phenotype.
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16
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New mechanisms in vein thrombosis: Immunothrombosis. Med Clin (Barc) 2019; 153:78-81. [PMID: 30803800 DOI: 10.1016/j.medcli.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 12/13/2022]
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17
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Salman A, Doherty P. To what extent is the variation in cardiac rehabilitation quality associated with patient characteristics? BMC Health Serv Res 2019; 19:3. [PMID: 30606181 PMCID: PMC6318968 DOI: 10.1186/s12913-018-3831-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 12/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Huge variability in quality of service delivery of cardiac rehabilitation (CR) in the UK. This study aimed to ascertain whether the variation in quality of CR delivery is associated with participants' characteristics. METHODS Individual patient data from 1 April 2013 to 31 March 2014 were collected electronically from the UK's National Audit of Cardiac Rehabilitation database. Quality of CR delivery is categorised as low, middle, and high based on six service-level criteria. The study included a range of patient variables: patient demographics, cardiovascular risk factors, comorbidities, physical and psychosocial health measures, and index of multiple deprivation. RESULTS The chance that a CR patient with more comorbidities attended a high-quality programme was 2.13 and 1.85 times higher than the chance that the same patient attended a low- or middle-quality programme, respectively. Patients who participated in high-quality CR programmes tended to be at high risk (e.g. increased waist size and high blood pressure); high BMI, low physical activity levels and high Hospital Anxiety and Depression Scale scores; and were more likely to be smokers, and be in more socially deprived groups than patients in low-quality programmes. CONCLUSIONS These findings show that the quality of CR delivery can be improved and meet national standards by serving a more multi-morbid population which is important for patients, health providers and commissioners of healthcare. In order for low-quality programmes to meet clinical standards, CR services need to be more inclusive in respect of patients' characteristics identified in the study. Evaluation and dissemination of information about the populations served by CR programmes may help low-quality programmes to be more inclusive.
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Affiliation(s)
- Ahmad Salman
- Department of Health Sciences, University of York, York, UK
- Ministry of Health, Kuwait City, Kuwait
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18
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Picado C, Pernigotti A, Arismendi E. Asthma: A New Cardiovascular Risk Factor? Arch Bronconeumol 2018; 55:353-354. [PMID: 30559032 DOI: 10.1016/j.arbres.2018.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 12/01/2022]
Affiliation(s)
- César Picado
- Servicio de Neumología y Alergia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), España
| | - Alberto Pernigotti
- Servicio de Cardiología, Hospital Clínic de Barcelona, Barcelona, España
| | - Ebymar Arismendi
- Servicio de Neumología y Alergia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), España.
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19
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Geake J, Bell SC. Bronchiectasis: Yet another systemic disease? Respirology 2018; 23:797-798. [PMID: 29717795 DOI: 10.1111/resp.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Abstract
See related Article
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Affiliation(s)
- James Geake
- Department of Thoracic Medicine, Lyell McEwin Hospital, Adelaide, SA, Australia
- Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Scott C Bell
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
- Lung Bacteria Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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20
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Lin SY, Lin CL, Lin CC, Wang IK, Hsu WH, Kao CH. Risk of acute coronary syndrome and peripheral arterial disease in chronic liver disease and cirrhosis: A nationwide population-based study. Atherosclerosis 2018; 270:154-159. [PMID: 29425961 DOI: 10.1016/j.atherosclerosis.2018.01.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/29/2018] [Accepted: 01/31/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND & AIMS Until now, no study has investigated the risks of acute coronary syndrome (ACS) and peripheral arterial disease (PAD) in cirrhosis. METHODS In this study, 57,214 patients diagnosed with cirrhosis between 2000 and 2010 were identified from the Taiwan National Health Insurance claims data. Each patient was randomly selected and frequency-matched with an individual without cirrhosis by age, sex, and index year. RESULTS The overall incidence rates of ACS and PAD were 2.81 and 2.97 per 1000 person-years, respectively, in the cirrhosis cohort. The cirrhosis cohort had a higher risk of ACS [adjusted subhazard ratio (aSHR) = 1.12, 95% confidence interval (CI) = 1.03-1.22] and PAD (aSHR = 1.11, 95% CI = 1.02-1.21). The risk of ACS was highest among members of the cirrhosis cohort with ascites (aSHR = 1.09, 95% CI = 1.11-1.19). CONCLUSIONS Patients with chronic liver disease and cirrhosis have higher risks of ACS and PAD than those without chronic liver disease and cirrhosis.
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Affiliation(s)
- Shih-Yi Lin
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taiwan; Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - I-Kuan Wang
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taiwan; Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taiwan; Division of Pulmonary and Critical Care Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taiwan; Department of Nuclear Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
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Podgórski M, Kupczyk M, Grzelak P, Bocheńska-Marciniak M, Polguj M, Kuna P, Stefańczyk L. Inhaled Corticosteroids in Asthma: Promoting or Protecting Against Atherosclerosis? Med Sci Monit 2017; 23:5337-5344. [PMID: 29120994 PMCID: PMC5691568 DOI: 10.12659/msm.904469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Bronchial asthma is an inflammatory disease of the respiratory system. However, it may also induce systemic effects. Although reports suggest patients with asthma are at increased risk of cardiovascular events, the association between asthma and atherosclerosis is unclear. The aim of the present study was to compare the progression of atherosclerosis between patients with asthma treated with inhaled corticosteroids and healthy controls. Material/Methods In 102 adult patients with asthma, markers of arterial stiffness (pulse wave velocity and augmentation index) were evaluated by applanation tonometry. Structural atherosclerotic changes (intima-media complex thickness and presence of atherosclerotic plaque) were assessed sonographically. Lipid profile and fasting glucose level were measured. Clinical data concerning the course of asthma, its severity, and management strategy were obtained. A group of 102 healthy, age-matched controls were examined according to the same protocol. Results The majority of patients presented well-controlled asthma of moderate severity. When adjusted for weight, age, and systolic blood pressure, no significant differences were observed in pulse wave velocity, in augmentation index, or in intima-media complex thickness between groups. In controls, atherosclerotic plaque occurred significantly more often than in patients with asthma (p=0.0226). Moreover, in patients with asthma, the intima-media complex thickness of the right common carotid artery was significantly correlated with forced expiratory volume in 1 second (R2=−0.2951, p=0.0083). There was no significant difference in any of the atherosclerosis markers between different types and doses of administered inhaled corticosteroids. Conclusions Patients with bronchial asthma presented a decreased risk of atherosclerosis in comparison to healthy controls.
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Affiliation(s)
- Michał Podgórski
- Department of Radiology and Diagnostic Imaging, Barlicki Hospital, Medical University of Łódź, Łódź, Poland
| | - Maciej Kupczyk
- Department of Internal Medicine, Asthma and Allergy, Barlicki Hospital, Medical University of Łódź, Łódź, Poland
| | - Piotr Grzelak
- Department of Radiology and Diagnostic Imaging, Barlicki Hospital, Medical University of Łódź, Łódź, Poland
| | | | - Michał Polguj
- Department of Angiology, Medical University of Łódź, Łódź, Poland
| | - Piotr Kuna
- Department of Internal Medicine, Asthma and Allergy, Barlicki Hospital, Medical University of Łódź, Łódź, Poland
| | - Ludomir Stefańczyk
- Department of Radiology and Diagnostic Imaging, Barlicki Hospital, Medical University of Łódź, Łódź, Poland
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Chung WS, Lin HH. Sex Differences in the Risk of Developing Acute Coronary Syndrome in Patients With Sleep Disorders: A Population-Based Cohort Study. Am J Mens Health 2017; 11:1560-1568. [DOI: 10.1177/1557988316651260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Studies that focus on the relationship between sex and the risk of acute coronary syndrome (ACS) are scant. The current study investigated the effects of sex differences in the risk of developing ACS in patients with sleep disorders (SDs). This longitudinal population-based cohort study evaluated the incidence and risk of ACS development in 40,232 men and 65,519 women newly diagnosed with SDs between 2002 and 2008 from the Longitudinal Health Insurance Database. The follow-up period began from the entry date and ended on the date of an ACS event or December 31, 2010. Univariable and multivariable Cox proportional hazard regression models were conducted to estimate the sex differences in the risk of ACS. Men with SDs exhibited an increased incidence of ACS compared with women with SDs in all age- and comorbidity-specific subgroups. After covariates were adjusted, the men with SDs exhibited a 1.48-fold adjusted hazard ratio (aHR) of ACS compared with the women with SDs (95% confidence interval [CI] = 1.36-1.60). After age group stratification, the men with SDs in the young adult group exhibited the highest risk of subsequent ACS development compared with the women with SDs (aHR = 2.07, 95% CI = 1.69-2.55), followed by those in middle-aged adults (aHR = 1.52, 95% CI = 1.32-1.76) and older adults groups (aHR = 1.24, 95% CI = 1.11-1.39). This study determined that men with SDs, particularly young men, are at a higher risk of subsequent ACS development compared with women with SDs.
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Affiliation(s)
- Wei-Sheng Chung
- Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
- China Medical University, Taichung, Taiwan
- Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Hsuan-Hung Lin
- Central Taiwan University of Science and Technology, Taichung, Taiwan
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Wang L, Gao S, Yu M, Sheng Z, Tan W. Association of asthma with coronary heart disease: A meta analysis of 11 trials. PLoS One 2017; 12:e0179335. [PMID: 28609456 PMCID: PMC5469478 DOI: 10.1371/journal.pone.0179335] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 05/26/2017] [Indexed: 12/12/2022] Open
Abstract
PURPOSE While the relationship of asthma and coronary heart disease (CHD) (a specific manifestation of cardiovascular disease) has not been described consistently, we tried to defined this relation and explore the influence of gender and asthma status (child- and adult-onset asthma) on this issue. METHODS We searched published reports that described the relationship of asthma and CHD. RESULTS Eleven trials were identified, covering 666,355 subjects. Asthma overall was significantly associated with CHD both for prospective trials (HR 1.34 [1.09,1.64], P = 0.005) and for retrospective trials(OR 1.29 [1.13,1.46], P = 0.001), when compared to individuals without asthma. Subgroup analysis split by gender indicated that females with asthma were significantly associated with CHD (HR 1.40 [1.20,1.62], P<0.001), but males with asthma were not significantly related with CHD (HR 1.19 [0.98,1.44], P = 0.07). For the four subgroups (Females with adult-onset asthma,males with adult-onset asthma,females with child-onset asthma,and males with child-onset asthma), pooled analysis of two trials indicated that only females with adult-onset asthma were significantly associated with CHD (HR 2.06 [1.32,3.19], P<0.001). CONCLUSIONS Our data indicated that asthma was associated with CHD, and the relationship between them seemed to derived mostly from females with adult-onset asthma. Considering the limits of our study, these findings should be taken with caution.
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Affiliation(s)
- Lida Wang
- Department of E.N.T, Weifang People’s Hospital, Weifang, China
| | - Shuyan Gao
- Department of Hematology, Weifang People’s Hospital, Weifang, China
| | - Mingdong Yu
- Department of Orthopaedics, Weifang People’s Hospital, Weifang, China
| | - Zhixin Sheng
- Department of Hematology, Weifang People’s Hospital, Weifang, China
| | - Wei Tan
- Department of Respiration, Weifang People’s Hospital, Weifang, China
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Liu H, Fu Y, Wang K. Asthma and risk of coronary heart disease: A meta-analysis of cohort studies. Ann Allergy Asthma Immunol 2017; 118:689-695. [PMID: 28433577 DOI: 10.1016/j.anai.2017.03.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/02/2017] [Accepted: 03/14/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Few studies have investigated the incidence of coronary heart disease (CHD) in patients with asthma, and their results remain inconclusive. OBJECTIVE To conduct a meta-analysis to determine whether asthma increases the risk of CHD. METHODS A systematic literature search of the PubMed and Embase databases from inception to August 2016, complemented with references screening of relevant articles and reviews, was performed to identify eligible studies. Only longitudinal cohort studies were included in our meta-analysis. RESULTS The retrieval process yielded 7 studies (12 asthma cohorts) with 495,024 patients. Data pooling across the cohorts revealed that asthma was associated with an increased risk of CHD (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.30-1.57; P < .001), without significant heterogeneity across the studies (I2 = 26%, P = .19). This epidemiologic association was more pronounced in female than in male patients (female: HR, 1.50; 95% CI, 1.41-1.59; male: HR, 1.31; 95% CI, 1.16-1.47; P for interaction = .046). In addition, subgroup and sensitivity analyses supported the positive correlation between asthma and incident CHD. CONCLUSION Asthma is related to an increased incidence of CHD, particularly in women. Clinicians should be aware of this association when faced with a patient with asthma. Further investigations are required to examine how this excess risk should be managed in routine practice.
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Affiliation(s)
- Huai Liu
- Department of Respiratory Medicine, Jingmen No. 2 People's Hospital, Jingmen, Hubei, China.
| | - Ying Fu
- Medical School of Jingchu University of Technology, Jingmen, Hubei, China
| | - Kunpeng Wang
- Hubei University of Medicine, Shiyan, Hubei, China
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25
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Rolfes MC, Juhn YJ, Wi CI, Sheen YH. Asthma and the Risk of Rheumatoid Arthritis: An Insight into the Heterogeneity and Phenotypes of Asthma. Tuberc Respir Dis (Seoul) 2017; 80:113-135. [PMID: 28416952 PMCID: PMC5392483 DOI: 10.4046/trd.2017.80.2.113] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/03/2016] [Accepted: 12/08/2016] [Indexed: 01/05/2023] Open
Abstract
Asthma is traditionally regarded as a chronic airway disease, and recent literature proves its heterogeneity, based on distinctive clusters or phenotypes of asthma. In defining such asthma clusters, the nature of comorbidity among patients with asthma is poorly understood, by assuming no causal relationship between asthma and other comorbid conditions, including both communicable and noncommunicable diseases. However, emerging evidence suggests that the status of asthma significantly affects the increased susceptibility of the patient to both communicable and noncommunicable diseases. Specifically, the impact of asthma on susceptibility to noncommunicable diseases such as chronic systemic inflammatory diseases (e.g., rheumatoid arthritis), may provide an important insight into asthma as a disease with systemic inflammatory features, a conceptual understanding between asthma and asthma-related comorbidity, and the potential implications on the therapeutic and preventive interventions for patients with asthma. This review discusses the currently under-recognized clinical and immunological phenotypes of asthma; specifically, a higher risk of developing a systemic inflammatory disease such as rheumatoid arthritis and their implications, on the conceptual understanding and management of asthma. Our discussion is divided into three parts: literature summary on the relationship between asthma and the risk of rheumatoid arthritis; potential mechanisms underlying the association; and implications on asthma management and research.
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Affiliation(s)
| | - Young Jun Juhn
- Department of Pediatric and Adolescent Medicine/Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Youn Ho Sheen
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, Korea
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Abstract
BACKGROUND Previous studies have demonstrated that asthma might be associated with an increase in cardiovascular disease (CVD) and death. However, this relationship differs by gender. OBJECTIVES To systematically evaluate the association of asthma on the incidence of CVD and death in cohort studies. DESIGN Fixed and random effects models were used to calculate risk estimates in a meta-analysis. Potential publication bias was calculated using a funnel plot, Begg's rank correlation test, and Egger's linear regression test. SEARCH STRATEGY We searched the PubMed and Embase databases for studies that examined the relationship between asthma and CVD or all-cause mortality. SELECTION CRITERIA Prospective and retrospective cohort studies. RESULTS Ten studies containing 406 426 participants were included. The summary relative risk (95% confi-dence interval, CI) for patients with asthma was 1.33 (95% CI: 1.15-1.53), for CVD in women, it was 1.55 (95% CI: 1.20-2.00), for CVD in men it was 1.20 (95% CI: 0.92-1.56), and for all-cause mortality in both genders it was 1.36 (95% CI: 1.01-1.83). These findings remained consistent after sensitivity analysis. CONCLUSION The results indicate that asthma was associated with an increased risk of CVD and all-cause mortality. SYSTEMATIC REVIEW REGISTRATION NUMBER Systematic review was not registered.
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Affiliation(s)
| | | | - Xiangjun Yang
- Dr. Xiangjun Yang,, NO. 188, Shizi Street, Suzhou, 215006, China, T: +86 5121810, , ORCID: http://orcid.org/0000-0001-7309-3111
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27
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Chung WS, Lin HH, Ho FM, Lai CL, Chao CL. Risks of acute coronary syndrome in patients with osteoarthritis: a nationwide population-based cohort study. Clin Rheumatol 2016; 35:2807-2813. [PMID: 27585925 DOI: 10.1007/s10067-016-3391-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/14/2016] [Accepted: 08/19/2016] [Indexed: 02/07/2023]
Abstract
Recent studies have reported that osteoarthritis (OA) is related to inflammation and atherosclerosis. Studies on the relationship between OA and acute coronary syndrome (ACS) are scant. We evaluated the risk of ACS in OA patients of an Asian population. This longitudinal, population-based cohort study investigated the incidence and risk of ACS in 46,042 patients with newly diagnosed OA and 46,042 controls selected randomly from the general population and frequency matched according to age, sex, and entry year (2002-2003). The follow-up period ranged from the entry date until the date of an ACS event, loss to follow-up, or the end of 2010. We employed Cox proportional hazard models to estimate the effects of OA on the risk of ACS. The OA patients showed a 15 % higher risk of ACS than did the controls after adjustment for covariates (adjusted hazard ratio [aHR] = 1.15, 95 % confidence interval [CI] = 1.08-1.23). The risk of ACS in the OA patients was the greatest in young adults (aHR = 2.0, 95 % CI = 1.44-2.78), followed by middle-aged (aHR = 1.15, 95 % CI = 1.01-1.31) and older adults (aHR = 1.11, 95 % CI = 1.03-1.20). The risk of ACS was 1.96-fold in young adults with mild to moderate OA and 3.51-fold in young adults with severe OA compared with their counterparts without OA. OA carries an increased risk of ACS, particularly in young adults with severe OA. Clinicians should employ proactive strategies for preventing ACS occurrence in these patients.
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Affiliation(s)
- Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, No. 199, Section 1, San-Min Road, Taichung, 40343, Taiwan. .,Department of Health Services Administration, China Medical University, Taichung, Taiwan. .,Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan.
| | - Hsuan-Hung Lin
- Department of Management Information Systems, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Feng-Ming Ho
- Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chung-Liang Lai
- Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Chia-Lun Chao
- Department of Internal Medicine, Lotung Poh-Ai Hospital, Yilan, Taiwan
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Nabavizadeh SH, Farahbakhsh N, Fazel A, Mosavat F, Anushiravani A. Severe angina pectoris in asthma attack: a case report. Electron Physician 2016; 8:2591-4. [PMID: 27504177 PMCID: PMC4965212 DOI: 10.19082/2591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 04/20/2016] [Indexed: 11/24/2022] Open
Abstract
Asthma is a chronic inflammatory disorder of the airways related to the obstruction of reversible airflow. Asthma presents as recurrent attacks of cough and dyspnea. Poor control causes recurrent admissions to the ICU, and mortality is related to poor drug compliance and follow-up. Angina pectoris is a syndrome of recurrent chest discomfort related to myocardial ischemia. The presence of these two disorders rarely has been reported. We reported a 12-year-old boy who was referred with exacerbation of asthma and developed angina pectoris during hospitalization. He had labored breathing and diffuse wheezing. During treatment of the asthma, the patient developed severe chest pain due to shunt formation and coronary hypoxia, caused by the sole administration of ventolin, since oxygen had been disconnected. After receiving appropriate therapy, both his asthma and angina recovered, and, to date, he has not experienced angina pectoris again.
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Affiliation(s)
- Seyed Hesamedin Nabavizadeh
- M.D., Professor, Department of Immunology and Allergy, Faculty of Medicine, Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazanin Farahbakhsh
- M.D., Faculty Member, Department of Pediatrics, Faculty of Medicine, Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Fazel
- M.D., Faculty Member, Department of Immunology and Allergy, Faculty of Medicine, Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshteh Mosavat
- M.D., Faculty Member, Department of Immunology and Allergy, Faculty of Medicine, Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Anushiravani
- M.D., Faculty Member, Department of Internal Medicine, Faculty of Medicine, Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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29
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Shen TC, Lin CL, Wei CC, Chen CH, Tu CY, Hsia TC, Shih CM, Hsu WH, Sung FC, Kao CH. Bidirectional Association between Asthma and Irritable Bowel Syndrome: Two Population-Based Retrospective Cohort Studies. PLoS One 2016; 11:e0153911. [PMID: 27093172 PMCID: PMC4836663 DOI: 10.1371/journal.pone.0153911] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 04/06/2016] [Indexed: 12/13/2022] Open
Abstract
Background There is a demonstrated association between asthma and irritable bowel syndrome (IBS). In this study, we examined the bidirectional association between asthma and IBS using a nationwide database. Methods We conducted two retrospective cohort studies using data obtained from the National Health Insurance of Taiwan. Study 1 included 29,648 asthma patients newly diagnosed between 2000 and 2010. Study 2 included 29,875 IBS patient newly diagnosed between 2000 and 2010. For each study, four subjects without asthma and IBS were selected, respectively, frequency-matched by sex, age, and the diagnosis date. All four cohorts were followed up until the end of 2011 to estimate incident IBS for Study 1 and incident asthma for study 2. Adjusted hazard ratios (aHRs) were estimated using the Cox proportional hazards model after controlling for sex, age and comorbidities. Results The incidence of IBS was 1.89 times higher in the asthma cohort than in the comparison cohort (8.26 vs. 4.36 per 1,000 person-years), with an aHR of 1.57 [95% confidence interval (CI) = 1.47–1.68]. The aHRs remained significant in all subgroups measured by sex, age and the presence of comorbidities. In contrast, the incidence of asthma was 1.76 times higher in the IBS cohort than the comparison cohort (7.09 vs. 4.03 per 1,000 person-years), with an aHR of 1.54 (95% CI = 1.44−1.64). Similarly, aHRs remained significant in all subgroups measured by sex, age and the presence of comorbidities. Conclusion The present study suggests a bidirectional association between asthma and IBS. Atopy could be a shared pathophysiology underlying this association, deserving a further investigation.
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Affiliation(s)
- Te-Chun Shen
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chang-Ching Wei
- Children’s Hospital, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chia-Hung Chen
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Yen Tu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Te-Chun Hsia
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chuen-Ming Shih
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wu-Huei Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
- * E-mail: (CHK); (FCS)
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- * E-mail: (CHK); (FCS)
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30
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Yao CW, Shen TC, Lu CR, Wang YC, Lin CL, Tu CY, Hsia TC, Shih CM, Hsu WH, Sung FC. Asthma Is Associated With a Subsequent Risk of Peripheral Artery Disease: A Longitudinal Population-Based Study. Medicine (Baltimore) 2016; 95:e2546. [PMID: 26817901 PMCID: PMC4998275 DOI: 10.1097/md.0000000000002546] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Asthma has been associated with the atherosclerosis risk, but not clear of peripheral artery disease (PAD). We attempted to examine the risk of PAD in patients with asthma.From the insurance claims data of Taiwan, we identified 28,158 newly diagnosed asthma patients in 2000 to 2005 and 56,316 persons without asthma randomly selected into the comparison cohort, frequency matched by sex, age, and the date of diagnosis. Both cohorts were followed up until the end of 2011 to estimate the incident PAD. Adjusted hazard ratios (aHRs) of PAD were estimated using the Cox proportional hazards model after controlling for sex, age, and comorbidities.The incidence of PAD was 1.46 times higher in the asthma cohort than in the comparison cohort, with an aHR of 1.34 [95% confidence interval (CI) = 1.24-1.45]. Incidence of PAD was higher in men, the aged, and those with comorbidities in both cohorts. The aHRs of PAD remained significant for the asthma cohort in all subgroups of sex, age, and the presence of comorbidity. The aHRs of PAD were 14.1 (95% CI = 8.18-24.5) in asthma patients with multiple emergency visits and 22.3 (95% CI = 15.6-31.9) for those with multiple hospitalizations.Although smoking is a potential confounding factor, this study suggests patients with asthma have a significantly higher risk of developing PAD than the general population. The results also support the notion that poor control of asthma status is a key factor in subsequent PAD development.
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Affiliation(s)
- Chih-Wei Yao
- From the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital (C-WY, T-CS, C-YT, T-CH, C-MS, W-HH); Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University (T-CS, F-CS); Division of Cardiology, Department of Internal Medicine (C-RL); Management Office for Health Data, China Medical University Hospital (Y-CW, C-LL, F-CS); Department of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan (F-CS)
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31
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Sneeboer MMS, Majoor CJ, de Kievit A, Meijers JCM, van der Poll T, Kamphuisen PW, Bel EH. Prothrombotic state in patients with severe and prednisolone-dependent asthma. J Allergy Clin Immunol 2015; 137:1727-1732. [PMID: 26714414 DOI: 10.1016/j.jaci.2015.10.038] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/18/2015] [Accepted: 10/30/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Epidemiologic studies have shown that asthmatic patients, in particular those with severe disease, have increased risk of pulmonary embolism. It is unknown whether these patients have a prothrombotic state under stable conditions. OBJECTIVE We sought to compare coagulation and fibrinolysis parameters between healthy subjects and patients with mild, severe, and prednisolone-dependent asthma under stable conditions and to investigate whether hemostatic markers correlate with airway inflammation. METHODS In 126 adults (33 healthy control subjects, 31 patients with mild asthma, 32 patients with severe asthma, and 30 patients with prednisolone-dependent asthma) parameters of inflammation (peripheral blood eosinophils and neutrophils) and markers of hemostasis (endogenous thrombin potential [ETP], thrombin-antithrombin complex, plasmin-α2-antiplasmin complex, plasminogen activator inhibitor type 1 [PAI-1], D-dimer, and von Willebrand factor [vWF]) were measured in plasma. One-way ANOVA with the post hoc Bonferroni test was used for group comparison, and linear regression analysis was used for correlations. RESULTS We observed increased ETP (121% vs 99%, overall P < .01), plasmin-α2-antiplasmin complex (520 vs 409 μg/L, overall P = .04), PAI-1 (10 vs 7 ng/mL, overall P = .02), and vWF (142% vs 87%, overall P < .01) levels in asthmatic patients compared with healthy control subjects. ETP, PAI-1, and vWF levels increased with increasing asthma severity. In addition, we found a correlation between ETP and vWF with neutrophil but not eosinophil counts. CONCLUSION Asthmatic patients have a prothrombotic state that increases with asthma severity. This might explain why patients with asthma, in particular those with severe disease, have an increased risk of venous thromboembolism.
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Affiliation(s)
- Marlous M S Sneeboer
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Christof J Majoor
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne de Kievit
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost C M Meijers
- Department of Experimental Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Plasma Proteins, Sanquin Research, Amsterdam, The Netherlands
| | - Tom van der Poll
- Center of Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter W Kamphuisen
- Department of Vascular Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth H Bel
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Risk of Obstructive Sleep Apnea in Adult Patients with Asthma: A Population-Based Cohort Study in Taiwan. PLoS One 2015; 10:e0128461. [PMID: 26067280 PMCID: PMC4466235 DOI: 10.1371/journal.pone.0128461] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 04/27/2015] [Indexed: 11/19/2022] Open
Abstract
Background There are several publications reported that obstructive sleep apnea (OSA) was associated with asthma. However, large-scaled, population-based cohort study has been limited. We aimed to examine the risk of OSA among adult patients with asthma in an Asian population. Methods We conducted a retrospective cohort study using data from the National Health Insurance (NHI) of Taiwan. The asthma cohort included 38,840 newly diagnosed patients between 2000 and 2010. The date of diagnosis was defined as the index date. Each patient was randomly matched with four people without asthma according to gender, age, and the index year as the comparison cohort. The occurrence of OSA was followed up until the end of 2011. The risk of OSA was estimated using the Cox proportional hazard model after adjusting for gender, age, and comorbidities. Results The overall incidence of OSA was 2.51-fold greater in the asthma cohort than in the comparison cohort (12.1 versus 4.84 per 1000 person-years). Compared to non-asthma subjects, the adjusted hazard ratio (aHR) of OSA increased to 1.78 for asthma patients with one or less annual emergency room (ER) visit, and 23.8 for those who visited ER more than once per year. In addition, aHR in patients with inhaled steroid treatment compared to those without steroid treatment was 1.33 (95% CI = 1.01–1.76). Conclusion Patients with asthma have a significantly higher risk of developing OSA than the general population. The results suggest that the risk of OSA is proportional to asthma control and patients with inhaled steroid treatment have a higher risk for OSA than those without steroid treatment.
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