Reduced carotid atherosclerosis in asthmatic patients treated with inhaled corticosteroids

Abstract

Although inflammation is an important component of atherosclerosis, it is unknown whether inhaled corticosteroids (ICS) as anti-inflammatory drugs prevent atherosclerosis.In the present study, carotid atherosclerosis was evaluated by ultrasonography in 150 asthmatic patients who had been regularly treated with ICS, and in 150 matched nonasthmatic controls, with an assessment of atherosclerotic risk factors.Carotid intima-media thickness was significantly lower in the asthmatic patients than in the controls. The prevalence of carotid plaque tended to be lower in the asthmatic patients than in the controls. Defined carotid atherosclerosis was diagnosed in 51 of the asthmatic patients, who were older, with a higher prevalence of males, a higher prevalence of dyslipidaemia and a lower mean daily dose of ICS than the 99 patients without carotid atherosclerosis. Stepwise multiple logistic regression analysis identified age, male sex and dyslipidaemia as positive risk factors for carotid atherosclerosis. The mean daily dose of ICS was a negative risk factor.Carotid atherosclerosis is reduced in asthmatic patients treated with ICS compared with matched controls. This study suggests that ICS may have protective effects against atherosclerosis.

Slaying the CVD dragon with steroids

“…In this study, the leading risk factors for increased carotid wall thickness were, not surprisingly, older age, dyslipidaemia and male sex, which comprise three of the five Framingham Heart Study risk factors [10]. However, contrary to expectations, the mean daily dose of ICS was also associated with atherosclerosis such that patients who were using the highest doses of ICS had the lowest risk while those using the lowest doses had the highest risk, suggesting that ICS is protective against atherosclerosis [9]. The use of other anti-asthma medications, such as b 2 -agonists, leukotriene receptor antagonists and theophylline, made no difference to the risk of atherosclerosis.…”

“…However, recent disappointing results of torcetrapib (which dramatically raised high-density lipoprotein cholesterol) [4], combination therapy with fenofibrate and simvastatin (which reduced low-density lipoprotein cholesterol) [5] and renin-angiotensin system blockers (which reduced blood pressure) [6,7] for the attenuation of cardiovascular events beyond standard therapy have been sobering; these findings have suggested that we may have reached the limits of risk reduction with these interventions, and raise an urgent call to find novel pathways and targets to further fight the large burden of IHD and stroke worldwide. Unfortunately, there is a dearth of promising compounds in the pipeline and many large pharmaceutical companies, including Pfizer, have abandoned CVD drug development altogether, after a decade of repeated failures [8].The report in this issue of European Respiratory Journal by OTSUKI et al [9], showing that inhaled corticosteroids (ICS) are associated with reduced atherosclerosis in patients with asthma, is welcome news for patients with CVD. In this carefully conducted case-control study of 150 patients with asthma and 150 healthy control subjects, OTSUKI et al [9] showed that patients with asthma in general had lower burden of carotid atherosclerosis, as determined by high-resolution ultrasound B-mode imaging studies demonstrating reduced intimal and medial wall thickness and reduced plaque formation in the carotid arteries, in spite of a higher prevalence of smoking among asthmatic than control subjects.…”

“…The report by OTSUKI et al [9] suggests that ICS, which have been used for decades in the treatment of inflammatory airway diseases, may have a salient role in protecting against atherosclerosis. If these data can be confirmed by a large randomised controlled trial, we may be able to at least partially slay the CVD dragon, which, by 2030, will be responsible for one out of every three deaths worldwide (representing 24.2 million deaths per annum) [24], and revolutionise the way in which we treat heart disease.…”

“…The report in this issue of European Respiratory Journal by OTSUKI et al [9], showing that inhaled corticosteroids (ICS) are associated with reduced atherosclerosis in patients with asthma, is welcome news for patients with CVD. In this carefully conducted case-control study of 150 patients with asthma and 150 healthy control subjects, OTSUKI et al [9] showed that patients with asthma in general had lower burden of carotid atherosclerosis, as determined by high-resolution ultrasound B-mode imaging studies demonstrating reduced intimal and medial wall thickness and reduced plaque formation in the carotid arteries, in spite of a higher prevalence of smoking among asthmatic than control subjects.…”

“…In this carefully conducted case-control study of 150 patients with asthma and 150 healthy control subjects, OTSUKI et al [9] showed that patients with asthma in general had lower burden of carotid atherosclerosis, as determined by high-resolution ultrasound B-mode imaging studies demonstrating reduced intimal and medial wall thickness and reduced plaque formation in the carotid arteries, in spite of a higher prevalence of smoking among asthmatic than control subjects. In this study, the leading risk factors for increased carotid wall thickness were, not surprisingly, older age, dyslipidaemia and male sex, which comprise three of the five Framingham Heart Study risk factors [10].…”