Acute asthma increases the incidence of cardiovascular events
Published online: July 16, 2019
Asthma and cardiovascular diseases are major public health problems in the United States (US), accounting for approximately 340,000 hospital admissions for asthma and 610,000 hospital admissions for acute myocardial infarction (or “heart attack”). Previous large observational studies have reported that patients with asthma have a higher incidence of cardiovascular diseases (such as acute myocardial infarction and stroke) through chronic activation of inflammatory cytokines followed by systemic and vascular inflammation. Additionally, acute inflammatory processes (e.g., severe infection, pneumonia, and influenza virus infection) have been linked to acute cardiovascular diseases. Despite the large burden of asthma, little had been known about the effect of acute asthma on cardiovascular events.
In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Raita and colleagues investigated the effect of acute asthma on cardiovascular diseases. The authors conducted a self-controlled case series study using large population-based data of three diverse states (Florida, Nebraska, and New York) in the U.S. from 2011-2014. Self-controlled case series design is used for comparisons of the risks of cardiovascular events before and after asthma exacerbations within patients. In this design, each patient serves as his/her own control, which minimizes confounding, and robustly estimates causal effects. This design also is more efficient than other study designs, meaning the estimates of effects will be more precise.
In the analysis of 4,607 adults hospitalized for acute asthma who had a first episode of acute myocardial infarction or ischemic stroke, the researchers found that acute asthma was associated with a 5-fold higher incidence of acute myocardial infarction and ischemic stroke, particularly in the first 1-week period after acute asthma. This finding was also found in the younger patient population and patients without concurrent chronic obstructive pulmonary disease. This article presents several clinical implications. First, this finding supports a role of acute inflammation among patients with acute asthma in the development of cardiovascular events, and suggests the need for further investigation into the mechanisms linking acute asthma to cardiovascular events and to the development of early interventions for cardiovascular morbidities (e.g., targeting inflammatory pathways among patients with high inflammatory markers). Second, considering the substantial health burden of asthma in the U.S., clinicians and policy makers need to be fully aware of the opportunities to apply cardiovascular prevention measures to patients with acute asthma during hospitalization and transition to outpatient care.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.