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Wong JYY, Blechter B, Liu Z, Shi J, Roger VL. Genetic susceptibility to chronic diseases leads to heart failure among Europeans: the influence of leukocyte telomere length. Hum Mol Genet 2024; 33:1262-1272. [PMID: 38676403 PMCID: PMC11227624 DOI: 10.1093/hmg/ddae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Genetic susceptibility to various chronic diseases has been shown to influence heart failure (HF) risk. However, the underlying biological pathways, particularly the role of leukocyte telomere length (LTL), are largely unknown. We investigated the impact of genetic susceptibility to chronic diseases and various traits on HF risk, and whether LTL mediates or modifies the pathways. METHODS We conducted prospective cohort analyses on 404 883 European participants from the UK Biobank, including 9989 incident HF cases. Multivariable Cox regression was used to estimate associations between HF risk and 24 polygenic risk scores (PRSs) for various diseases or traits previously generated using a Bayesian approach. We assessed multiplicative interactions between the PRSs and LTL previously measured in the UK Biobank using quantitative PCR. Causal mediation analyses were conducted to estimate the proportion of the total effect of PRSs acting indirectly through LTL, an integrative marker of biological aging. RESULTS We identified 9 PRSs associated with HF risk, including those for various cardiovascular diseases or traits, rheumatoid arthritis (P = 1.3E-04), and asthma (P = 1.8E-08). Additionally, longer LTL was strongly associated with decreased HF risk (P-trend = 1.7E-08). Notably, LTL strengthened the asthma-HF relationship significantly (P-interaction = 2.8E-03). However, LTL mediated only 1.13% (P < 0.001) of the total effect of the asthma PRS on HF risk. CONCLUSIONS Our findings shed light onto the shared genetic susceptibility between HF risk, asthma, rheumatoid arthritis, and other traits. Longer LTL strengthened the genetic effect of asthma in the pathway to HF. These results support consideration of LTL and PRSs in HF risk prediction.
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Affiliation(s)
- Jason Y Y Wong
- Epidemiology and Community Health Branch, National Heart Lung and Blood Institute, 10 Center Drive, Bethesda, MD 20892, United States
| | - Batel Blechter
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, United States
| | - Zhonghua Liu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032, United States
| | - Jianxin Shi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, United States
| | - Véronique L Roger
- Epidemiology and Community Health Branch, National Heart Lung and Blood Institute, 10 Center Drive, Bethesda, MD 20892, United States
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Chen Q, Zhou H, Tang J, Sun Y, Ao G, Zhao H, Chang X. An analysis of exogenous harmful substance exposure as risk factors for COPD and hypertension co-morbidity using PSM. Front Public Health 2024; 12:1414768. [PMID: 38983261 PMCID: PMC11231093 DOI: 10.3389/fpubh.2024.1414768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/03/2024] [Indexed: 07/11/2024] Open
Abstract
Background Some occupational and environmental exposures could increase the risk of chronic obstructive pulmonary disease (COPD) and hypertension in various work and living environments. However, the effect of exposure to multiple exogenous harmful substances on COPD and hypertension co-morbidities remains unclear. Methods Participants were selected from eight hospitals in five provinces in China using a multistage cluster sampling procedure. Participants' demographic, exposure, and disease information were collected through questionnaires, spirometry, and blood pressure examinations. Demographic data were used as matching factors, and 1:1 matching between the exposed and non-exposed groups was performed by employing propensity score matching (PSM) to minimize the influence on the results. A one-way chi-squared analysis and multifactorial logistic regression were used to analyze the association between the exposure to exogenous harmful substances (metals and their compound dust, inorganic mineral dust, organic chemicals, and livestock by-products) and the co-morbidity of COPD and hypertension. Results There were 6,610 eligible participants in the final analysis, of whom 2,045 (30.9%) were exposed to exogenous harmful substances. The prevalence of co-morbidities of COPD and hypertension (6.0%) in the exposure group was higher than their prevalence in the total population (4.6%). After PSM, exogenous harmful substance exposure was found to be a risk factor for the co-morbidity of COPD and hypertension [odds ratio (OR) = 1.347, 95% confidence interval (CI): 1.011-1.794], which was not statistically significant before PSM (OR = 1.094, 95% CI: 0.852-1.405). Meanwhile, the results of different outcomes showed that the association between hypertension and exogenous harmful substance exposure was not statistically significant (OR = 0.965, 95% CI: 0.846-1.101). Smoking (OR = 4.702, 95% CI: 3.321-6.656), history of a respiratory disease during childhood (OR = 2.830, 95% CI: 1.600-5.006), and history of respiratory symptoms (OR = 1.897, 95% CI: 1.331-2.704) were also identified as risk factors for the co-morbidity of COPD and hypertension. Conclusion The distribution of exogenous harmful substance exposure varies in the population, and the prevalence of co-morbidities is generally higher in susceptible populations. Exposure to exogenous harmful substances was found to be a key risk factor after adjusting for demographic confounders.
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Affiliation(s)
- Qingyang Chen
- Department of Toxicology, School of Public Health, Lanzhou University, Lanzhou, China
| | - Haodong Zhou
- Department of Toxicology, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jiarong Tang
- Department of Toxicology, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yingbiao Sun
- Department of Toxicology, School of Public Health, Lanzhou University, Lanzhou, China
| | - Geriletu Ao
- Department of Pulmonary and Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, China
| | - Hongjun Zhao
- Department of Pulmonary and Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, China
| | - Xuhong Chang
- Department of Toxicology, School of Public Health, Lanzhou University, Lanzhou, China
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Caplan M, Hamzaoui O. Cardio-respiratory interactions in acute asthma. Front Physiol 2023; 14:1232345. [PMID: 37781226 PMCID: PMC10540856 DOI: 10.3389/fphys.2023.1232345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
Asthma encompasses of respiratory symptoms that occur intermittently and with varying intensity accompanied by reversible expiratory airflow limitation. In acute exacerbations, it can be life-threatening due to its impact on ventilatory mechanics. Moreover, asthma has significant effects on the cardiovascular system, primarily through heart-lung interaction-based mechanisms. Dynamic hyperinflation and increased work of breathing caused by a sharp drop in pleural pressure, can affect cardiac function and cardiac output through different mechanisms. These mechanisms include an abrupt increase in venous return, elevated right ventricular afterload and interdependence between the left and right ventricle. Additionally, Pulsus paradoxus, which reflects the maximum consequences of this heart lung interaction when intrathoracic pressure swings are exaggerated, may serve as a convenient bedside tool to assess the severity of acute asthma acute exacerbation and its response to therapy.
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Affiliation(s)
- Morgan Caplan
- Service de Médecine Intensive Réanimation, Hôpital Robert Debré, Université de Reims, Reims, France
| | - Olfa Hamzaoui
- Service de Médecine Intensive Réanimation, Hôpital Robert Debré, Université de Reims, Reims, France
- Unité HERVI, Hémostase et Remodelage Vasculaire Post-Ischémie, Reims, France
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Echocardiographic Evaluation of the Cardiac Chambers in Asthmatic Patients: The BADA (Blood Pressure Levels, Clinical Features and Markers of Subclinical Cardiovascular Damage of Asthma Patients) Study-ECO. J Pers Med 2022; 12:jpm12111847. [PMID: 36579553 PMCID: PMC9694451 DOI: 10.3390/jpm12111847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
The "Blood pressure levels, clinical features and markers of subclinical cardiovascular Damage of Asthma patients" (BADA) study is aimed at defining the cardiovascular risk profile and the markers of subclinical and clinical vascular and cardiac damage in asthmatic patients. Very few studies have assessed asthmatic patients without concomitant heart disease through a transthoracic echocardiogram. The goal of the present study is to investigate the prevalence of morphology and/or function changes in the cardiac chambers of a sample of 86 patients with chronic asthma, referred to the dedicated outpatient unit of the Division of Respiratory Diseases of the AOUP "P. Giaccone" of the University of Palermo, and the results obtained were compared with those of a control group without respiratory or cardiovascular diseases. Patients with asthma showed a marked and widespread involvement of the four cardiac chambers compared with the controls: enlargement of the two atria, greater left ventricular remodeling with interventricular septal thickening, increased indexed left ventricular mass with a significantly greater percentage of patients with overt left ventricular hypertrophy, worse left ventricular diastolic function proven by the significant difference in the E/A ratio, and worse right ventricular systolic function with global right ventricular dysfunction estimated by the Myocardial Performance Index (Tei Index). Multivariate regression analysis, after adjustment for essential hypertension, hypertension severity, diabetes, Body Mass Index, and creatinine clearance, seems to indicate that the indexed left ventricular mass, right atrial volume, and right ventricular Tei index (but not left ventricular hypertrophy) correlate significantly with asthma, severe asthma, and FEV1 (and to a lesser extent with asthma duration). No correlation is apparent between inhaled therapy (ICS, SABA) and myocardial involvement. These results seem to confirm that a more in-depth cardiovascular evaluation in patients with chronic respiratory disease allows the identification of unrecognized cardiovascular involvement. A transthoracic echocardiogram performed in asthmatic patients without clinically overt signs or symptoms of cardiovascular impairment has identified some features indicative of an early subclinical cardiac impairment not found in the control group. These findings, considering also the higher frequency of hypertension in the asthma group, deserve further validation in the future.
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Chen H, Chen W, Zheng L. Genetic liability to asthma and risk of cardiovascular diseases: A Mendelian randomization study. Front Genet 2022; 13:879468. [PMID: 35957680 PMCID: PMC9360591 DOI: 10.3389/fgene.2022.879468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background and Aims: Epidemiological studies have suggested positive associations between asthma and the risk of cardiovascular diseases (CVDs). However, causality remains inconclusive. We aim to explore the causal associations between asthma and CVDs risk using the Mendelian Randomization (MR) approach. Methods: We obtained summary-level data for eight CVDs [including atrial fibrillation (AF), coronary artery disease (CAD), heart failure (HF), stroke, ischemic stroke, large artery stroke, small vessel stroke, and cardioembolic stroke] from several large genome-wide association studies (GWASs) and the FinnGen consortium. Nine lead single-nucleotide polymorphisms associated with asthma (p < 5 × 10−8) were identified from the GWAS conducted by the Trans-National Asthma Genetic Consortium. MR analyses were performed using the inverse variance weighted method, supplemented by the weighted median and MR-Egger methods. Results: Inverse variance weighted method showed suggestive effects of genetically determined asthma on AF (odds ratio (OR), 1.08; 95% confidence interval (CI), 1.02, 1.14; p = 0.009) and HF (OR, 1.05; 95% CI, 1.01, 1.09; p = 0.029). We found no causal associations between asthma and other CVDs. No horizontal pleiotropy was observed. Conclusion: This MR study provides genetic evidence suggesting a causal association between asthma and the risk of AF and HF, although not at the level of significance after multiple testing correction. Programs aimed at treating asthma among asthmatics might help prevent the adverse health effects inflicted by CVDs.
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Affiliation(s)
- Heng Chen
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Chen
- Department of Respiratory and Critical Care Medicine, Ruian People’s Hospital, Wenzhou, China
| | - Liangrong Zheng
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Liangrong Zheng,
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Geng C, Feng Y, Yang Y, Yang H, Li Z, Tang Y, Wang J, Zhao H. Allergic asthma aggravates angiotensin Ⅱ-induced cardiac remodeling in mice. Transl Res 2022; 244:88-100. [PMID: 35108660 DOI: 10.1016/j.trsl.2022.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/13/2022] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
Cardiovascular disease remains the leading cause of death globally, and heart failure (HF) represents its terminal stage. Asthma, one of the most common chronic diseases, has been reported to be associated with an increased risk of cardiovascular disease. However, the link between asthma and HF has rarely been studied, and the possible mechanisms by which asthma affects HF are unclear. This study aimed to explore the influence of asthma on HF and the possible mechanisms. We analyzed data from the National Health and Nutrition Examination Survey and found a higher prevalence of HF among asthmatic individuals, and identified an independent association between HF and asthma. Subsequently, we produced mice with concurrent ovalbumin (OVA) sensitization-induced allergic asthma and angiotensin Ⅱ infusion-induced cardiac remodeling to explore the effect of asthma on cardiac remodeling in vivo. The results showed that OVA-induced asthma impaired heart function and aggravated cardiac remodeling in mice. We also found that OVA sensitization increased the expression levels of immunoglobulin E (IgE) in serum and IgE receptor (FcεR1) in the heart, and enhanced the activation of downstream signaling molecules of IgE-FcεR1 in the heart. Importantly, blockage of IgE-FcεR1 using FcεR1-deficient mice or an anti-IgE antibody prevented asthma-induced decline of cardiac function, and alleviated cardiac remodeling. These findings demonstrate the adverse effects of allergic asthma on the heart, and suggest the potential application of anti-IgE therapy in the treatment of asthma complicated with heart conditions.
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Key Words
- AKT, protein kinase B
- ANP, natriuretic peptide type A
- Ang Ⅱ, angiotensin Ⅱ
- BALF, bronchioalveolar lavage fluid
- BMI, body mass index
- BNP, natriuretic peptide type B
- BW, body weight
- CAD, coronary heart disease
- COPD, chronic obstructive pulmonary disease
- CVD, cardiovascular disease
- EF, ejection fraction
- FS, fraction shortening
- HF, heart failure
- HW, heart weight
- IgE, immunoglobulin E
- LVAW, left ventricular anterior wall
- LVID, left ventricular internal dimension
- LVPW, left ventricular posterior wall
- NHANES, National Health and Nutrition Examination Survey
- OVA, ovalbumin
- TC, total cholesterol
- TG, triglyceride
- WGA, wheat germ agglutinin
- WT, wild type
- pSmad2/3, phosphorylated small mothers against decapentaplegic 2 and 3
- α-SMA, α-smooth muscle actin
- β-MHC, β-myosin heavy chain
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Affiliation(s)
- Chi Geng
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yufan Feng
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yang Yang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Hongqin Yang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Zhiwei Li
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yaqin Tang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Jing Wang
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.
| | - Hongmei Zhao
- Department of Pathophysiology, State Key Laboratory of Medical Molecular Biology Institute of Basic Medicine, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China.
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Guo J, Zhang Y, Liu T, Levy BD, Libby P, Shi GP. Allergic asthma is a risk factor for human cardiovascular diseases. NATURE CARDIOVASCULAR RESEARCH 2022; 1:417-430. [PMID: 39195946 DOI: 10.1038/s44161-022-00067-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/08/2022] [Indexed: 08/29/2024]
Abstract
Asthma is an allergic airway disease in which type 2-mediated inflammation has a pathogenic role. Cardiovascular diseases (CVDs) are type 1-dominant inflammatory diseases in which type 2 cytokines often have a protective role. However, clinical studies demonstrate that allergic asthma and associated allergies are essential risk factors for CVD, including coronary heart diseases, aortic diseases, peripheral arterial diseases, pulmonary embolism, right ventricular dysfunction, atrial fibrillation, cardiac hypertrophy and even hypertension. Mast cells, eosinophils, inflammatory cytokines and immunoglobulin (Ig)E accumulate in asthmatic lungs and in the injured heart and vasculature of patients with CVD. Clinical studies show that many anti-asthmatic therapies affect the risk of CVD. As such, allergic asthma and CVD may share common pathogenic mechanisms. Preclinical investigations indicate that anti-asthmatic drugs have therapeutic potential in certain CVDs. In this Review, we discuss how asthma and allied allergic conditions may contribute to the prevalence, incidence and progression of CVD and vice versa.
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Affiliation(s)
- Junli Guo
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Key Laboratory of Tropical Cardiovascular Diseases Research of Hainan Province & Key Laboratory of Emergency and Trauma of Ministry of Education, the First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yuanyuan Zhang
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Key Laboratory of Tropical Cardiovascular Diseases Research of Hainan Province & Key Laboratory of Emergency and Trauma of Ministry of Education, the First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Tianxiao Liu
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Bruce D Levy
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Peter Libby
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Guo-Ping Shi
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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Zhou Y, Liang ZS, Jin Y, Ding J, Huang T, Moore JH, Zheng ZJ, Huang J. Shared Genetic Architecture and Causal Relationship Between Asthma and Cardiovascular Diseases: A Large-Scale Cross-Trait Analysis. Front Genet 2022; 12:775591. [PMID: 35126453 PMCID: PMC8811262 DOI: 10.3389/fgene.2021.775591] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/08/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Accumulating evidence has suggested that there is a positive association between asthma and cardiovascular diseases (CVDs), implying a common architecture between them. However, the shared genetic architecture and causality of asthma and CVDs remain unclear. Methods: Based on the genome-wide association study (GWAS) summary statistics of recently published studies, our study examined the genetic correlation, shared genetic variants, and causal relationship between asthma (N = 127,669) and CVDs (N = 86,995–521,612). Statistical methods included high-definition likelihood (HDL), cross-trait meta-analyses of large-scale GWAS, transcriptome-wide association studies (TWAS), and Mendelian randomization (MR). Results: First, we observed a significant genetic correlation between asthma and heart failure (HF) (Rg = 0.278, P = 5 × 10−4). Through cross-trait analyses, we identified a total of 145 shared loci between asthma and HF. Fifteen novel loci were not previously reported for association with either asthma or HF. Second, we mapped these 145 loci to a total of 99 genes whose expressions are enriched in a broad spectrum of tissues, including the seminal vesicle, tonsil, appendix, spleen, skin, lymph nodes, breast, cervix and uterus, skeletal muscle, small intestine, lung, prostate, cardiac muscle, and liver. TWAS analysis identified five significant genes shared between asthma and HF in tissues from the hemic and immune system, digestive system, integumentary system, and nervous system. GSDMA, GSDMB, and ORMDL3 are statistically independent genetic effects from all shared TWAS genes between asthma and HF. Third, through MR analysis, genetic liability to asthma was significantly associated with heart failure at the Bonferroni-corrected significance level. The odds ratio (OR) is 1.07 [95% confidence interval (CI): 1.03–1.12; p = 1.31 × 10−3] per one-unit increase in loge odds of asthma. Conclusion: These findings provide strong evidence of genetic correlations and causal relationship between asthma and HF, suggesting a shared genetic architecture for these two diseases.
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Affiliation(s)
- Yi Zhou
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Zhi-Sheng Liang
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Jiayuan Ding
- College of Arts and Sciences, Boston University, Boston, MA, United States
| | - Tao Huang
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jason H. Moore
- Department of Biostatistics, Epidemiology and Informatics, Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Jie Huang
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
- *Correspondence: Jie Huang,
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Ng CACM, Knuiman MW, Murray K, Divitini ML, Musk AWB, James AL. Childhood asthma and cardiovascular morbidity and mortality in adulthood: The Busselton Health Study. Pediatr Pulmonol 2021; 56:1915-1923. [PMID: 33819390 DOI: 10.1002/ppul.25386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/14/2021] [Accepted: 03/23/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Long-term childhood asthma studies that investigate adult outcomes other than respiratory morbidity are lacking. This study examines the associations of childhood asthma and the occurrence of cardiovascular disease (CVD) events and mortality in adulthood. METHODS A cohort of 4430 school children (aged 17 years) who attended the Busselton Health Study between 1967 and 1983 were analyzed. Self-reported history of doctor-diagnosed asthma was determined based on the questionnaire. Subsequent CVD events (hospital admissions or death) up to 2014 were identified using the Western Australia Data Linkage System. Cox regression models were used to investigate the impact of childhood asthma on CVD events and mortality in adulthood. A subgroup of 2153 participants who re-attended a survey in young adulthood was also analyzed. RESULTS A total of 462 (10%) of the cohort had childhood asthma. During follow-up, 867 participants experienced a CVD event and 22 participants died from CVD. Childhood asthma was not associated with the risk of CVD events in adulthood (HR, 1.12; 95% CI: 0.91-1.39; p = .2833) and this persisted after adjustment for confounders. Childhood asthma was not associated with coronary heart disease events (HR, 0.72; 95% CI: 0.40-1.30; p = .2761), heart failure events (HR, 0.55; 95% CI: 0.07-4.13; p = .5604) or CVD mortality (HR, 0.91; 95% CI: 0.21-3.89; p = .8987) in adulthood. CONCLUSION Childhood asthma is not associated with the risk of CVD events and mortality in adulthood.
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Affiliation(s)
- Christopher A C M Ng
- Medical School, The University of Western Australia, Perth, Australia.,Sir Charles Gairdner Hospital, Perth, Australia
| | - Matthew W Knuiman
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Mark L Divitini
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Arthur W Bill Musk
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Alan L James
- Medical School, The University of Western Australia, Perth, Australia.,Sir Charles Gairdner Hospital, Perth, Australia
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10
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Miran SM, Nelson SJ, Zeng-Treitler Q. A model-agnostic approach for understanding heart failure risk factors. BMC Res Notes 2021; 14:184. [PMID: 34001210 PMCID: PMC8130447 DOI: 10.1186/s13104-021-05596-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/05/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Understanding the risk factors for developing heart failure among patients with type 2 diabetes can contribute to preventing deterioration of quality of life for those persons. Electronic health records (EHR) provide an opportunity to use sophisticated machine learning models to understand and compare the effect of different risk factors for developing HF. As the complexity of the model increases, however, the transparency of the model often decreases. To interpret the results, we aimed to develop a model-agnostic approach to shed light on complex models and interpret the effect of features on developing heart failure. Using the HealthFacts EHR database of the Cerner EHR, we extracted the records of 723 patients with at least 6 yeas of follow up of type 2 diabetes, of whom 134 developed heart failure. Using age and comorbidities as features and heart failure as the outcome, we trained logistic regression, random forest, XGBoost, neural network, and then applied our proposed approach to rank the effect of each factor on developing heart failure. RESULTS Compared to the "importance score" built-in function of XGBoost, our proposed approach was more accurate in ranking the effect of the different risk factors on developing heart failure.
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Affiliation(s)
- Seyed M Miran
- Biomedical Informatics Center, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
| | - Stuart J Nelson
- Biomedical Informatics Center, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Qing Zeng-Treitler
- Biomedical Informatics Center, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
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11
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Karakaya Z, Cavkaytar Ö, Tosun Ö, Arga M. Subclinical cardiovascular dysfunction in children and adolescents with asthma. J Asthma 2020; 59:451-461. [PMID: 33251886 DOI: 10.1080/02770903.2020.1856866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is close association between asthma and cardiovascular functions as both diseases share common inflammatory pathways. The current study was aimed at investigating the risk factors, associated with endothelial and cardiac functions in children with newly-diagnosed mild-persistent asthma. METHODS A total of 33 steroid-naive asthmatic children [median(interquartile-range); 9.1 years(7.8-13.5)] and 16 healthy controls [11.5 years(9.9-13.6)] were included. Their demographic, clinical and laboratory findings were recorded. Carotid Artery intima-media thickness (CIMT), stiffness, distensibility and strain were measured as atheroclerosis markers. Conventional and tissue Doppler imaging was performed to evaluate ventricular function. RESULTS The patients with asthma had higher CIMT and stiffness and lower strain and distensibility compared to controls (p < 0.001 for all). There was a significant correlation between the duration of asthmatic symptoms and subclinical-atherosclerosis as well as peripheral eosinophil count (p < 0.001, p < 0.05). The patients had lower tricuspid-annular-plane-systolic-excursion (TAPSE), ejection time, and higher isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), and left ventricle myocardial performance index (LVMPI) than the control subjects (p < 0.001 for all). A positive correlation was also observed between the duration of asthmatic-symptoms and cardiac-function parameters. CONCLUSION Children with mild persistent asthma had subclinical atherosclerosis and ventricular dysfunction even in the early stage of disease. Symptom duration was closely associated with both subclinical atherosclerosis and ventricular dysfunction. Myocardial performance index was abnormal in the asthmatic children when assessed by tissue Doppler Imaging even though they had normal ejection fraction in conventional echocardiography. Future prospective studies with larger sample sizes are needed to confirm these findings and to assess the possible protective effect of ICSs in the prevention of subclinical atherosclerosis.
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Affiliation(s)
- Zeynep Karakaya
- Department of Pediatrics, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Özlem Cavkaytar
- Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Öykü Tosun
- Department of Pediatric Cardiology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Mustafa Arga
- Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
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Teodorescu M, Nyenhuis SM, Prasad B. Reply to Mehmood: Asthma and Obstructive Sleep Apnea: Taking It to Heart. Am J Respir Crit Care Med 2020; 201:1448-1449. [PMID: 32027805 PMCID: PMC7258636 DOI: 10.1164/rccm.202001-0151le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mihaela Teodorescu
- William S. Middleton Memorial Veterans HospitalMadison, Wisconsin.,University of Wisconsin School of Medicine and Public HealthMadison, Wisconsin
| | - Sharmilee M Nyenhuis
- Jesse Brown VA Medical CenterChicago, Illinoisand.,University of Illinois at ChicagoChicago, Illinois
| | - Bharati Prasad
- Jesse Brown VA Medical CenterChicago, Illinoisand.,University of Illinois at ChicagoChicago, Illinois
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13
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Mehmood M. Asthma and Obstructive Sleep Apnea: Taking It to Heart. Am J Respir Crit Care Med 2020; 201:1447-1448. [PMID: 32027809 PMCID: PMC7258646 DOI: 10.1164/rccm.201912-2537le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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14
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Prognostic role of bronchial asthma in patients with heart failure. Heart Vessels 2020; 35:808-816. [PMID: 31970511 DOI: 10.1007/s00380-020-01555-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/10/2020] [Indexed: 12/25/2022]
Abstract
There are few reports investigating the relationship between bronchial asthma (BA) and heart failure (HF). We hypothesized BA may have impact on prognosis in patients with HF. Among 323 consecutive outpatients with HF, 191 patients without chronic obstructive pulmonary disease were analyzed. Twenty patients had BA, most of whom (80.0%) had preserved left ventricular ejection fraction (LVEF ≥ 50%). The use of β-blockers was less frequent (55.0% vs 83.0%. p = 0.01), systolic blood pressure (133 ± 22 vs 120 ± 17 mmHg, p = 0.003), and heart rate (83 ± 14 vs 74 ± 15 bpm, p = 0.02) were higher in patients with BA than those without BA. During median follow up of 24 months, 45 (23.6%) experienced primary outcome defined as a composite of all-cause death, nonfatal myocardial infarction, nonfatal ischemic stroke, and unexpected hospitalization due to HF. Multivariate Cox regression analysis revealed that the presence of BA was independently associated with the occurrence of primary outcome (hazard ratio 3.08, 95% CI 1.42-6.71, p = 0.004). In the subgroup analysis of patients with preserved LVEF, patients with BA exhibited worse outcomes (p = 0.03 by log-rank). Patients with HF complicated by BA, most of whom had preserved LVEF, exhibited worse outcomes than those without BA.
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15
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Ash SY, Sanchez-Ferrero GV, Schiebler ML, Rahaghi FN, Rai A, Come CE, Ross JC, Colon AG, Cardet JC, Bleecker ER, Castro M, Fahy JV, Fain SB, Gaston BM, Hoffman EA, Jarjour NN, Lempel JK, Mauger DT, Tattersall MC, Wenzel SE, Levy BD, Washko GR, Israel E, San Jose Estepar R. Estimated Ventricular Size, Asthma Severity, and Exacerbations: The Severe Asthma Research Program III Cohort. Chest 2019; 157:258-267. [PMID: 31521672 DOI: 10.1016/j.chest.2019.08.2185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/25/2019] [Accepted: 08/11/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Relative enlargement of the pulmonary artery (PA) on chest CT imaging is associated with respiratory exacerbations in patients with COPD or cystic fibrosis. We sought to determine whether similar findings were present in patients with asthma and whether these findings were explained by differences in ventricular size. METHODS We measured the PA and aorta diameters in 233 individuals from the Severe Asthma Research Program III cohort. We also estimated right, left, and total epicardial cardiac ventricular volume indices (eERVVI, eELVVI, and eETVVI, respectively). Associations between the cardiac and PA measures (PA-to-aorta [PA/A] ratio, eERVVI-to-eELVVI [eRV/eLV] ratio, eERVVI, eELVVI, eETVVI) and clinical measures of asthma severity were assessed by Pearson correlation, and associations with asthma severity and exacerbation rate were evaluated by multivariable linear and zero-inflated negative binomial regression. RESULTS Asthma severity was associated with smaller ventricular volumes. For example, those with severe asthma had 36.1 mL/m2 smaller eETVVI than healthy control subjects (P = .003) and 14.1 mL/m2 smaller eETVVI than those with mild/moderate disease (P = .011). Smaller ventricular volumes were also associated with a higher rate of asthma exacerbations, both retrospectively and prospectively. For example, those with an eETVVI less than the median had a 57% higher rate of exacerbations during follow-up than those with eETVVI greater than the median (P = .020). Neither PA/A nor eRV/eLV was associated with asthma severity or exacerbations. CONCLUSIONS In patients with asthma, smaller cardiac ventricular size may be associated with more severe disease and a higher rate of asthma exacerbations. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01761630; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA.
| | | | - Mark L Schiebler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Ashish Rai
- Department of Medicine, North Shore Medical Center, Salem, MA
| | - Carolyn E Come
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - James C Ross
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Alysha G Colon
- College of Medicine, University of Florida, Gainesville, FL
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Medicine, University of South Florida, Tampa, FL
| | - Eugene R Bleecker
- Division of Genetics, Genomics and Precision Medicine, University of Arizona, Tucson, AZ
| | - Mario Castro
- Division of Pulmonary and Critical Care Medicine, Washington University, St. Louis, MO
| | - John V Fahy
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA
| | - Sean B Fain
- Departments of Medical Physics, Radiology, and Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Benjamin M Gaston
- Division of Pulmonology, Allergy, and Immunology, and Pediatric Pulmonology, Rainbow Babies and Children's Hospital and Cleveland Medical Center, Cleveland, OH
| | - Eric A Hoffman
- Departments of Radiology, Biomedical Engineering, and Medicine, University of Iowa, Iowa City, IA
| | - Nizar N Jarjour
- Division of Pulmonary and Critical Care Medicine (Dr Jarjour), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jason K Lempel
- Department of Radiology, Cleveland Clinic, Cleveland, OH
| | - David T Mauger
- Division of Biostatistics and Bioinformatics, Penn State Eberly College of Science, University Park, PA
| | - Matthew C Tattersall
- Division of Cardiovascular Medicine (Dr Tattersall), University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sally E Wenzel
- Division of Pulmonary, Allergy and Critical Care, University of Pittsburgh, Pittsburgh, PA
| | - Bruce D Levy
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
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16
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Marques de Mello L, Cruz ÁA. A proposed scheme to cope with comorbidities in asthma. Pulm Pharmacol Ther 2018; 52:41-51. [PMID: 30149069 DOI: 10.1016/j.pupt.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/16/2018] [Accepted: 08/20/2018] [Indexed: 02/07/2023]
Abstract
The prevalence of non-communicable chronic diseases has been on the rise and the co-occurrence of morbidities is becoming more common. Multimorbidities are found more frequently among women, those with a history of mental disorders, lower level of schooling, and unfavorable socioeconomic condition. Physical inactivity, smoking and obesity are also associated with multimorbidities. Its occurrence is directly related to the age, affecting the majority of the individuals with more than 50 years old. It is important to consider the possibility of comorbid conditions that aggravate, complicate or simulate the symptoms of the disease in the face of a patient with asthma and poor response to treatment. Among subjects with asthma, some conditions stand out as the most frequent: chronic rhinitis or rhinosinusitis, gastroesophageal reflux disease, obstructive sleep apnea syndrome, obesity, and cardiovascular disorders. Comorbidities reduce the chances of optimal asthma control. It is essential to assess and manage properly these complex situations, choosing wisely preventive strategies and treatment options to avoid adverse events and optimize outcomes. Medications for asthma have the potential to worsen cardiovascular conditions, while beta-adrenergic receptor blockers and angiotensin conversion enzyme inhibitors used for cardiovascular conditions, can worsen asthma. Handling properly these cases will save lives and resources. However, there are multiple gaps in knowledge requiring investigation in this field to inform integrated care pathways and policies. It is likely information may be obtained from real life studies and electronic medical databases. Communications between the providers and patients may be facilitated by electronic technology, opening a large window for guided self-management.
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Affiliation(s)
| | - Álvaro A Cruz
- ProAR - Federal University of Bahia School of Medicine, Brazil
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17
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Sun D, Li X, Heianza Y, Nisa H, Shang X, Rabito F, Kelly T, Harville E, Li S, He J, Bazzano L, Chen W, Qi L. History of Asthma From Childhood and Arterial Stiffness in Asymptomatic Young Adults: The Bogalusa Heart Study. Hypertension 2018; 71:928-936. [PMID: 29632104 PMCID: PMC5898648 DOI: 10.1161/hypertensionaha.118.10916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/05/2018] [Accepted: 03/05/2018] [Indexed: 12/12/2022]
Abstract
Asthma is related to various cardiovascular risk. Whether a history of asthma from childhood contributes to arterial stiffness in adulthood, a noninvasive surrogate for cardiovascular events, is unknown. Prospective analyses were performed among 1746 Bogalusa Heart Study participants aged 20 to 51 years with data on self-report asthma collected since childhood. Aorta-femoral pulse wave velocity (af-PWV, m/s) was repeatedly assessed among adults ≥aged 18 years. Generalized linear mixed models and generalized linear models were fitted for the repeated measurements of af-PWV and its changes between the last and the first measurements, respectively. After a median follow-up of 11.1 years, participants with a history of asthma from childhood had a higher af-PWV (6.78 versus 6.13; P=0.048) and a greater increase in af-PWV (8.99 versus 2.95; P=0.043) than those without asthma, adjusted for age, sex, race, smoking status, heart rate, body mass index, systolic blood pressure, lipids, and glycemia. In addition, we found significant interactions of asthma with body mass index and systolic blood pressure on af-PWV and its changes (P for interaction <0.01). The associations of asthma with af-PWV and its changes appeared to be stronger among participants who were overweight and obese (body mass index ≥25 kg/m2) or with prehypertension and hypertension (systolic blood pressure ≥120 mm Hg) compared with those with a normal body mass index or systolic blood pressure. Our findings indicate that a history of asthma from childhood is associated with higher af-PWV and greater increases in af-PWV, and such associations are stronger among young adults who are overweight or with elevated blood pressure.
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Affiliation(s)
- Dianjianyi Sun
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Xiang Li
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Yoriko Heianza
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Hoirun Nisa
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Xiaoyun Shang
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Felicia Rabito
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Tanika Kelly
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Emily Harville
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Shengxu Li
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Jiang He
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Lydia Bazzano
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Wei Chen
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.)
| | - Lu Qi
- From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., X.L., Y.H., H.N., F.R., T.K., E.H., S.L., J.H., L.B., W.C., L.Q.); Department of Public Health, Faculty of Medicine and Health Sciences, Syarif Hidayatullah State Islamic University, Jakarta, Indonesia (H.N.); Children's Hospital New Orleans, LA (X.S.); Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (L.Q.); and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.Q.).
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