Persistent Asthma Is Associated With Carotid Plaque in MESA

Blood Eosinophil Count in Asthma Is Associated With Increased Abdominal Aortic Diameter and Increased Vascular Stiffness

Background

Asthma is associated with atherosclerosis and abdominal aortic aneurysm (AAA). However, the underlying pathomechanisms remain elusive. Blood eosinophil count (BEC) is implicated in both eosinophilic asthma and arterial wall inflammation.

Objective

To explore the possible association of BEC in asthma and abdominal aortic artery changes.

Methods

112 outpatients were prospectively enrolled in this exploratory study. Abdominal aortic diameter was measured using ultrasonography imaging, while vascular speckle tracking was utilized to evaluate vascular strains. Patients were stratified into two groups, with n=66 patients with a BEC of ≥300 n/µL and n=46 patients with <300 n/µL. Both groups exhibited no significant disparities in cardiovascular risk factors; however, the high BEC group was more frequently male.

Results

The aortic diameter was wider in patients with a BEC ≥300 n/µL (1.46 ± 0.25 cm vs 1.67 ± 0.63 cm, p=0.018). Three patients were diagnosed with an AAA, all had a BEC ≥300 n/µL. Patients with a BEC ≥300 n/µL exhibited lower strain values, indicative of higher vascular stiffness, including radial strain (2.65 ± 1.38% vs 4.46 ± 2.59%; p<0.001). BEC exhibited a positive correlation with abdominal aortic diameter (R²=0.131, b=0.000, p<0.001), and a negative correlation with radial strain values (R²=0.131, b=-0.002, p=0.001) in sex-adjusted linear regression.

Conclusion

In patients with asthma, blood eosinophil count (BEC) is correlated with a wider aortic diameter and heightened vascular stiffness in the abdominal aorta. Hence, they may be at an elevated risk of developing an AAA.

Association between asthma and risk of cardiovascular disease in Korean adults

OBJECTIVES

Cardiovascular disease (CVD) is a major cause of death in Korea, and studies have reported that asthma can have a negative impact on CVD. This study aimed to identify the association between asthma and CVD, including the current status, treatment status, and duration of asthma in Korean adults.

METHODS

The Korea National Health and Nutrition Examination Survey (2016-2021) was used, and 34,384 adults aged 19 years or older were included. Exposures were asthma-related characteristics, and outcomes were hypertension, ischemic heart disease, and stroke. The association between asthma characteristics and CVD was analyzed using the chi-square test and multiple logistic regression analysis.

RESULTS

The asthma diagnosis experience rate of the population was 3.1%; 1.6% were currently suffering from asthma, 1.0% were receiving asthma treatment, 0.6% were receiving regular medication, and 1.5% had a disease duration of 11 years or more. The CVD diagnosis rates in the population were 20.2% for hypertension, 2.3% for ischemic heart disease, and 1.8% for stroke. Compared to those who had no asthma diagnosis, those who had been diagnosed with asthma (OR = 2.06, 95% CI = 1.47-2.87), received asthma treatment (OR = 1.93, 95% CI = 1.22-3.04), and had a long duration of asthma (OR = 3.54, 95% CI = 1.71-7.33) had a significantly higher risk of ischemic heart disease. However, hypertension and stroke were not significantly correlated with asthma-related characteristics.

CONCLUSIONS

Asthma diagnosis and asthma-related characteristics were associated with an increased risk of ischemic heart disease. Our study suggests that research on risk assessment and management of CVD in patients with asthma would be needed.

Blood eosinophil count is associated with early atherosclerotic artery changes in asthma

OBJECTIVE

Asthma is linked to atherosclerosis, yet the underlying mediators remain elusive. Eosinophils may contribute to both asthmatic and atherosclerotic inflammation. Hence, this study aimed to explore the potential associations of eosinophils with artery changes among patients with asthma.

METHODS

We assessed strain values of the common carotid arteries (CCAs) via vascular speckle tracking and compared asthma patients with low (< 300/µl) and high (≥ 300/µl) blood eosinophil counts (BEC).

RESULTS

We enrolled 100 patients, 42 with a BEC of < 300 and 58 with a BEC of ≥ 300 n/µl. Patients with high BEC exhibited more severe disease, characterized, e.g., by a higher frequency of acute exacerbations (1.3 ± 2.1 vs. 2.6 ± 2.4 n/year, p = 0.005). Both groups presented similar profiles in terms of conventional cardiovascular risk. The high BEC group demonstrated elevated arterial stiffness, reflected by reduced radial strain (mean radial strain of the right CCA: 2.7 ± 1.4% for BEC ≥ 300 n/µl vs. 3.5 ± 1.7% for BEC < 300 n/µl, p = 0.008; left CCA: 2.6 ± 1.4% vs. 4.1 ± 2.2%, p < 0.001). A weak yet statistically significant negative correlation was observed between BEC and radial strain for the right CCA (R2 = 0.131, b=-0.001, p = 0.001) and left CCA (R2 = 0.086, b=-0.001, p = 0.015). However, the prevalence of cerebrovascular disease was similar in both groups (31,0% vs. 50,0%, p = 0.057).

CONCLUSION

We identified a correlation between BEC and vascular stiffness, which supports the hypothesis that eosinophils may promote atherosclerosis.

CLINICAL TRIAL NUMBER

Due to the exploratory and predominantly retrospective nature of the study, trial registration was not conducted. The only prospective procedure conducted was the angiological sonography to evaluate the current state. No ensuing health-related interventions were performed specifically for this study.

Asthma and Cardiovascular Diseases: Navigating Mutual Pharmacological Interferences

Asthma and cardiovascular disease (CVD) often co-exist. When a patient has both conditions, management requires an approach that addresses the unique challenges of each condition separately, while also considering their potential interactions. However, specific guidance on the management of asthma in patients with CVD and on the management of CVD in patients with asthma is still lacking. Nevertheless, health care providers need to adopt a comprehensive approach that includes both respiratory and CVD health. The management of CVD in patients with asthma requires a delicate balance between controlling respiratory symptoms and minimising potential cardiovascular (CV) risks. In the absence of specific guidelines for the management of patients with both conditions, the most prudent approach would be to follow established guidelines for each condition independently. Careful selection of asthma medications is essential to avoid exacerbation of CV symptoms. In addition, optimal management of CV risk factors is essential. However, close monitoring of these patients is important as there is evidence that some asthma medications may have adverse effects on CVD and, conversely, that some CVD medications may worsen asthma symptoms. On the other hand, there is also increasing evidence of the potential beneficial effects of asthma medications on CVD and, conversely, that some CVD medications may reduce the severity of asthma symptoms. We aim to elucidate the potential risks and benefits associated with the use of asthma medications in patients with CVD, and the potential pulmonary risks and benefits for patients with asthma who are prescribed CVD medications.

Reply: Asthma and cardiovascular disease: the strength of triangulation

In their correspondence, M.C. Tattersall and co-workers noted that our study reports contrasting findings to some earlier studies, including their own. They have raised several methodological points regarding our triangulation approach which leveraged two wholly different methods (traditional observational study and Mendelian randomisation) and multiple entirely different datasets [1]. We have discussed each of their concerns here.

A triangulation approach integrated different epidemiological methods and data sources (large observational study and Mendelian randomisation study) to provide more reliable findings and reveal potential sources of bias in previous asthma–CHD studies https://bit.ly/3IXoK84

Discrimination, Smoking, and Cardiovascular Disease Risk: A Moderated Mediation Analysis With MESA

BACKGROUND

Carotid intima-media thickness (cIMT) and carotid plaque are reliable indicators of cardiovascular disease risk, and research highlights that racial and ethnic minority individuals generally exhibit higher cIMT and carotid plaque than White individuals. At present, the mechanisms driving these disparities among different racial and ethnic and biological sex groups are poorly understood.

METHODS AND RESULTS

Data came from the baseline examination of MESA (Multi-Ethnic Study of Atherosclerosis). A total of 6814 participants aged 45 to 84 years free of clinical cardiovascular disease completed assessments on health behavior and perceived discrimination. Four sex-stratified moderated mediation models examined associations between discrimination, cigarette smoking, and mean cIMT and plaque. We hypothesized that cigarette use would mediate the association between discrimination and carotid artery disease features, and that these would differ by race and ethnicity. Indirect effects of discrimination on plaque were observed among Hispanic women such that discrimination was associated with cigarette use and, in turn, higher plaque (β=0.04 [95% CI, 0.01-0.08]). Indirect effects of discrimination on mean cIMT were found among Hispanic (β=0.003 [95% CI, 0.0001-0.007]) and White men (β=0.04 [95% CI, 0.01-0.08]) such that discrimination was associated with cigarette use and, in turn, higher cIMT. Finally, a positive indirect effect of discrimination on plaque was observed among Hispanic men (β=0.03 [95% CI, 0.004-0.07]). No other racial and ethnic differences were observed.

CONCLUSIONS

To understand and address social determinants of cardiovascular disease, researchers must incorporate an intersectional framework that will allow us to understand the complex nature of discrimination and cardiovascular disease risk for individuals of varying intersecting identities and social positions.

Level of IL-6, TNF, and IL-1β and age-related diseases: a systematic review and meta-analysis

Introduction

Chronic low-grade inflammation is an important aspect of morbidity and mortality in older adults. The level of circulating pro-inflammatory cytokines (interleukin (IL)-6, tumor necrosis factor (TNF) or IL-1β) is a risk factor in cardiovascular and neurodegenerative diseases and is also associated with sarcopenia and frailties. The objective of this study was to assess each cytokine: IL-6, TNF, and IL-1β separately in the elderly with comorbidities against controls without diseases according to the data published in the available literature.

Methods

The electronic bibliographic PubMed database was systematically searched to select all the relevant studies published up to July 2023. The total number of the subjects involved in the meta-analysis included patients with diseases (n=8154) and controls (n=33967).

Results

The overall concentration of IL-6 was found to be higher in patients with diseases compared to controls and the difference was statistically significant, with a p-value of <0.001 (SMD, 0.16; 95% CI, 0.12-0.19). The heterogeneity was considerable with Q = 109.97 (P <0.0001) and I2 = 79.2%. The potential diagnostic usefulness of IL-6 was confirmed by odds ratio (OR) analysis (OR: 1.03, 95% CI (1.01; 1.05), p=0.0029). The concentration of both TNF and IL-1β was elevated in the control group compared to patients and amounted to SMD -0.03; 95% CI, -0.09-0.02, p-value 0.533 and SMD-0.29; 95% CI, -0.47- -0.12; p = 0.001, respectively. For TNF, however, the difference was statistically insignificant.

Discussion

IL-6, unlike TNF and IL-1β, could be a useful and convenient marker of peripheral inflammation in older adults with various comorbidities.

Asthma and cardiovascular disease: A bidirectional association?

See related article

Asthma as a Systemic Disease: Cardiovascular Effects Associated with Asthma

Asthma and cardiovascular disease (CVD) pose significant public health burdens. Airway inflammation is central to asthma pathophysiology and systemic inflammation, which occurs in asthma, is central to CVD pathophysiology. Numerous robust epidemiological studies have demonstrated deleterious systemic cardiovascular effects associated with the asthma syndrome. The cardiovascular effects associated with asthma include arterial injury, atherosclerotic CVD events, atrial fibrillation, and hypertension. Asthma is a heterogeneous disease, however, and the risk of CVD is not homogeneous across the various clinical phenotypes and molecular endotypes, highlighting prior inconsistent associations of asthma and its subtypes with various forms of CVD. The mechanistic underpinnings of the increased CVD risk in asthma remain multifactorial and undefined. Collectively, this supports the need for a precision approach in the identification of individuals with asthma who remain at elevated risk of development of cardiovascular diseases to guide both diagnostic and preventive interventions to decrease CVD risk among individuals living with asthma.