Cardiovascular disease risk associated with asthma and respiratory morbidity might be mediated by short-acting beta(2)-agonists

Copyright © 2009 American Academy of Allergy, Asthma & Immunology Published by Mosby, Inc.Background Studies examining the asthma-related risks of cardiovascular disease (CVD) events have generally used selected samples or did not control for the effects of β2-agonist use, itself associated with CVD events. Objectives We assessed the relationship between incident CVD/stroke and asthma and the effect of atopy while controlling for β2-agonist use in a representative adult population cohort free of CVD at baseline. Methods The North West Adelaide Health Study (stage 1, n = 3812; stage 2, n = 3113) assessed spirometry, anthropometry, atopy, blood pressure, and lipid levels. Questionnaires assessed doctor-diagnosed asthma and CVD (myocardial infarction and angina)/stroke, smoking status, and demographics. Asthma was defined by self-report or FEV1 reversibility. Current short- and long-acting β2-agonist use was identified at follow-up. Results Results are expressed as odds ratios (ORs) and 95% CIs. By using multivariable logistic regression, after adjustment for risk factors, in female subjects incident CVD/stroke events were associated with asthma (OR, 3.24; 95% CI, 1.55-6.78), with no effect modification by atopy (P for interaction = .61), and with as-required short-acting β2-agonist use (OR, 2.66; 95% CI, 1.06-6.61). In male subjects events were associated with daily cough/sputum (OR, 1.92; 95% CI, 1.05-3.50) and FEV1 of less than 80% of predicted value but an FEV1/forced vital capacity ratio of greater than 0.70 (OR, 2.15; 95% CI, 0.91-5.09; P = .08). Although few CVD/stroke events occurred in male subjects with asthma, a significant interaction with atopic status was found (P = .05). Conclusions Studies are required to elucidate how asthma exposes older women to excess macrovascular risk and prospectively determine the short-acting β2-agonist–related risk in persons without existing CVD. CVD risk in relation to atopic status of asthma also requires further investigation.Sarah L. Appleton, Richard E. Ruffin, David H. Wilson, Anne W. Taylor, Robert J. Adams and North West Adelaide Cohort Health Study Tea