Relation of Adult-Onset Asthma to Coronary Heart Disease and Stroke

Abstract

Asthma has been associated with atherosclerotic disease in several studies with some evidence that this association may be limited to women. However, most previous studies have failed to account for the heterogeneity of asthma subtypes. We previously reported increased carotid intima medial thickness among women with adult-onset asthma. In this study, we examine the association of adult and child-onset asthma with incident coronary heart disease (CHD) and stroke. Subjects were classified according to self-report of physician diagnosed asthma and age of asthma onset. We used Cox proportional hazards models to test the association of adult and child-onset asthma with incident CHD and stroke, testing for gender interaction. Subanalysis was also performed using only neversmokers. Women with adult-onset asthma experienced a 2-fold increase in incident CHD and stroke which was independent of other risk factors including smoking, body mass index, and physical activity and persisted when the analysis was restricted to never-smokers. No significant association was found among women with child-onset asthma or among men. In conclusion, adult-onset asthma may be a significant risk factor for CHD and stroke among women but not men. Keywords ASTHMA; CORONARY DISEASE; STROKE; SEX FACTORSAsthma has been associated with vascular disease, carotid atherosclerosis, coronary heart disease (CHD), or stroke in at least nine studies. 1-9 Among studies that present results stratified by gender, there is a suggestion that the association may be stronger among or entirely limited to women. 1-4 However, asthma is not a single disease but rather a collection of distinct underlying subtypes, with somewhat differing etiologies. 10,11 Child and adult-onset asthma differ in regards to asthma triggers 11 , gender distribution 11 , and systemic inflammation. 12 We previously reported an association between carotid intima medial thickness and adult-onset Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conflicts of NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript asthma among women in the Atherosclerosis Risk in Communities (ARIC) study. 4 This association was not observed among women with child-onset asthma or among men with either adult or child-onset asthma. In this study, we examined the association of asthma age of onset phenotypes with incidence of CHD and stroke according to gender within the ARIC cohort. Methods Study populationThe Atherosclerosis Risk in Communities (ARIC) Study is a prospective study of the etiology of atherosclerotic, cardiovascular, and cerebrova...

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