Matias E Pollevick1, Kevin Y Xu2, Grace Mhango3, Emily G Federmann3, Rajesh Vedanthan4, Paula Busse5, Fernando Holguin6, Alex D Federman3, Juan P Wisnivesky7. 1. Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Feinberg School of Medicine at Northwestern University, Chicago, IL. 2. Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO. 3. Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. 4. Department of Population Health, New York University School of Medicine, New York, NY; Department of Medicine, New York University School of Medicine, New York, NY. 5. Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Allergy and Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. 6. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Colorado, Denver, CO. 7. Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: juan.wisnivesky@mountsinai.org.
Abstract
BACKGROUND: Although asthma has been suggested as a risk factor for cardiovascular disease (CVD), robust longitudinal evidence of this relationship is limited. RESEARCH QUESTION: Using Framingham Offspring Cohort data, the goal of this study was to longitudinally examine the association between asthma and lifetime risk of CVD while controlling for cardiovascular risk factors included in the Framingham Risk Score. STUDY DESIGN AND METHODS: Data were analyzed from a prospective population-based cohort of 3,612 individuals, ages 17 to 77 years, who participated in Framingham Offspring Study examinations from 1979 to 2014. Asthma was defined based on physician diagnosis during study interviews. Incident CVD included myocardial infarction, angina, coronary insufficiency, stroke, transient ischemic attack, and heart failure. Time-dependent Cox regression models were used to evaluate the relationship between asthma and CVD incidence. RESULTS: Overall, 533 (15%) participants had a diagnosis of asthma and 897 (25%) developed CVD during the course of the study. Unadjusted analyses revealed that asthma was associated with increased CVD incidence (hazard ratio, 1.40; 95% CI, 1.17-1.68). Cox regression also showed an adjusted association between asthma and CVD incidence (hazard ratio, 1.28; 95% CI, 1.07-1.54) after controlling for established cardiovascular risk factors. INTERPRETATION: This prospective analysis with > 35 years of follow-up shows that asthma is a risk factor for CVD after adjusting for potential confounders. When assessing risk of cardiovascular disease, asthma should be evaluated and managed as a risk factor contributing to morbidity and mortality.
BACKGROUND: Although asthma has been suggested as a risk factor for cardiovascular disease (CVD), robust longitudinal evidence of this relationship is limited. RESEARCH QUESTION: Using Framingham Offspring Cohort data, the goal of this study was to longitudinally examine the association between asthma and lifetime risk of CVD while controlling for cardiovascular risk factors included in the Framingham Risk Score. STUDY DESIGN AND METHODS: Data were analyzed from a prospective population-based cohort of 3,612 individuals, ages 17 to 77 years, who participated in Framingham Offspring Study examinations from 1979 to 2014. Asthma was defined based on physician diagnosis during study interviews. Incident CVD included myocardial infarction, angina, coronary insufficiency, stroke, transient ischemic attack, and heart failure. Time-dependent Cox regression models were used to evaluate the relationship between asthma and CVD incidence. RESULTS: Overall, 533 (15%) participants had a diagnosis of asthma and 897 (25%) developed CVD during the course of the study. Unadjusted analyses revealed that asthma was associated with increased CVD incidence (hazard ratio, 1.40; 95% CI, 1.17-1.68). Cox regression also showed an adjusted association between asthma and CVD incidence (hazard ratio, 1.28; 95% CI, 1.07-1.54) after controlling for established cardiovascular risk factors. INTERPRETATION: This prospective analysis with > 35 years of follow-up shows that asthma is a risk factor for CVD after adjusting for potential confounders. When assessing risk of cardiovascular disease, asthma should be evaluated and managed as a risk factor contributing to morbidity and mortality.
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