Persistent Asthma Linked to Increased Carotid Plaque Presence, Burden

By Jeff Craven, MD /alert Contributor
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A significant percentage of individuals with persistent asthma had carotid plaque presence and burden compared with individuals who had intermittent asthma and those without asthma, according to recent research in the Journal of the American Heart Association.

“Carotid plaque assessment allows detection of both noncalcified and calcified plaques and can identify the atherosclerotic process early, providing important prognostic data before the later stages of atherosclerosis identified as calcified plaque on computed tomography imaging,” Matthew C. Tattersall, DO, MS, of the University of Wisconsin School of Medicine and Public Health, and colleagues wrote in their study.

Factors such as baseline inflammatory biomarkers did not explain the difference in carotid plaque among patients with persistent and intermittent asthma, the researchers said, who noted that atherosclerotic cardiovascular disease (ASCVD) risk for individuals with persistent asthma could be multifactorial. “Because asthma prevalence continues to increase and ASCVD remains the leading cause of death in the US, these diseases create a significant public health burden and emphasize the importance of additional studies to define their shared mechanistic underpinnings,” the researchers said.

In the MESA (Multi‐Ethnic Study of Atherosclerosis), Tattersall and colleagues evaluated 5,029 participants without previous ASCVD who were grouped into persistent or intermittent asthma categories based on whether they used controller medications. Participants were mean 61.6 years old, 53% were women, 26% were Black, 23% were Hispanic, and 12% were Chinese. The researchers measured the presence of carotid plaque with total plaque score (TPS) using B‐mode carotid ultrasound and used multivariable regression modeling with robust variances to analyze the relationship between asthma and carotid plaque burden.

The results showed 67% of participants with persistent asthma (TPS = 2.08) had carotid plaque compared with 48.5% of participants with intermittent asthma (TPS = 1.25) and 50% of participants without asthma (TPS = 1.29) (P ≤ .003). The researchers found IL-6 was significantly higher among participants with persistent asthma (1.89 pg/ml) compared with participants who did not have asthma (1.21 pg/ml) (P = .02). There was a significant association in fully adjusted models between persistent asthma and carotid plaque (OR = 1.83; 95% CI, 1.21-2.76; P < .001) and persistent asthma and TPS (P < .01). The results were not attenuated after adjusting for IL-6 at baseline (P = .02) or C-reactive protein (P = .01).

“The lack of association of intermittent asthma and carotid plaque measures is not unexpected, highlights the heterogeneity of the asthma syndrome, and supports our hypothesis that more severe forms of the disease may have more carotid arterial injury manifestations,” Tattersall and colleagues wrote.

“Because asthma prevalence continues to increase and ASCVD remains the leading cause of death in the United States, these diseases create a significant public health burden and emphasize the importance of additional studies to define their shared mechanistic underpinnings,” they concluded

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Disclosures: No authors declared financial ties to drugmakers. See full study for details.

Photo Credit: Getty Images.


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