Patients with persistent asthma have a higher carotid plaque burden and may be at greater risk of major adverse cardiovascular events such as heart attack or stroke, suggests a new study published in the Journal of the American Heart Association.¹ They also had higher levels of inflammatory biomarkers compared to those who did not have asthma.

This study analysed data of participants, aged 61 years (average), from the ongoing Multi-Ethnic Study of Atherosclerosis (MESA) study with the aim to explore a link between asthma and carotid artery plaque. The selected participants had undergone carotid artery ultrasound to detect carotid plaques and had baseline cardiovascular risk factors. Among the 5029 subjects included in this analysis, 388 had persistent asthma and used controller medication daily, 109 had intermittent asthma and did not use medication daily to control their symptoms, while the rest (n=4532) did not have asthma. CRP and IL-6 levels were also estimated. A total plaque score (TPS) was developed ranging from 0-12.

Results showed presence of carotid plaque in 67% of patients with persistent asthma vs 49.5% of patients with intermittent asthma and 50.5% of those without asthma. Participants with persistent asthma had on average, two carotid plaques, while subjects with intermittent asthma and no asthma had on average, one carotid plaque. The mean total plaque score was highest in patients with persistent asthma at 2.08 vs 1.29 in those without asthma and 1.25 in those with intermittent asthma.

The odds of having carotid plaques was doubled among patients with persistent asthma compared to those who did not have asthma after adjusting for multiple variables such as age, sex, race, weight, other medical comorbidities, prescription medications and smoking status with odds ratio of 1.83.

Patients with persistent asthma had higher levels of IL-6 vs those with no asthma; 1.89 pg/mL vs 1.52 pg/mL. The association between persistent asthma and carotid artery plaque still remained significant even after adjusting for baseline inflammatory biomarkers.

In this multiethnic study, two-thirds of patients with persistent asthma were found to have carotid plaques with high total plaque score, which were indicative of future cardiovascular events. Compared to carotid IMT, carotid plaque is a stronger and independent predictor of future ASCVD events, note the authors. These findings call for evaluation and/or referral of patients with persistent asthma for assessment of cardiovascular risk factors and carotid plaque for modification, if possible and better prognostication. However, the authors also caution that this is an observation study and the associations between asthma and carotid plaque “may not be causal”. Nevertheless, these patients must be encouraged to adopt a healthy lifestyle to mitigate the effect of the cardiovascular risk factors.

Reference

1. Tattersall MC, et al. Persistent asthma is associated with carotid plaque in MESA. J Am Heart Assoc. 2022 Nov 23;e026644. doi: 10.1161/JAHA.122.026644.