Persistent asthma linked to plaque buildup in arteries leading to the brain

Adults with persistent asthma may experience nearly twice the amount of plaque buildup in major arteries leading to the brain as people without asthma, raising their risk for a stroke, new research suggests.

The study, published Wednesday in the Journal of the American Heart Association, also found higher levels of inflammation in people with asthma, compared to those without the condition.

Asthma is a respiratory condition that can cause trouble breathing when airways become inflamed, often due to allergies. This type of chronic inflammation can contribute to a buildup of plaque in the arteries. When plaque in the arteries ruptures, it can lead to a heart attack or stroke. The vessels that carry blood through the neck to the brain are called the carotid arteries.

"Many physicians and patients don't realize that asthmatic airway inflammation may affect the arteries, so for people with persistent asthma, addressing risk factors for cardiovascular disease may be really helpful," lead study author Matthew C. Tattersall said in a news release. He is an assistant professor in the department of medicine at the University of Wisconsin in Madison.

"The presence and burden of carotid artery plaque is a strong predictor of future cardiovascular events," he said.

Cardiovascular disease is responsible for more deaths in the U.S. each year than all forms of cancer and chronic lower respiratory diseases combined.

Tattersall and his colleagues analyzed health data for a select group of adults who enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA) from 2000 to 2002. The study included people from Baltimore; Chicago; New York City; St. Paul, Minnesota; Los Angeles County, California; and Forsyth County, North Carolina. The 5,029 participants included in the analysis were an average 61 years old and were free from cardiovascular disease at study enrollment, but they had some cardiovascular disease risk factors, including being overweight, smoking, high cholesterol, high blood pressure or diabetes.

Participants were categorized as having intermittent, persistent or no asthma. Asthma was considered persistent if it required daily use of medication to keep symptoms under control. Ultrasound tests measured plaque in the carotid arteries on both sides of the neck, and blood tests measured inflammation.

Plaque was present in the carotid arteries of 67% of 109 people with persistent asthma, 49.5% of the 388 with intermittent asthma, and 50.5% of 4,532 people with no asthma. Participants with persistent asthma had nearly twice the amount of plaque as those with intermittent or no asthma. Compared to participants without asthma, those with persistent asthma also had higher levels of inflammation.

"This analysis tells us that the increased risk for carotid plaques among people with persistent asthma is probably affected by multiple factors," Tattersall said. "Participants who have persistent asthma had elevated levels of inflammation in their blood, even though their asthma was treated with medication, which highlights the inflammatory features of asthma. We know that higher levels of inflammation lead to negative effects on the cardiovascular system."

Other inflammatory disorders, such as lupus and arthritis, are included as risk factors in the 2019 AHA guidelines for the primary prevention of cardiovascular disease. This study adds to the understanding of how inflammatory diseases may affect cardiovascular health.

"Addressing cardiovascular risk factors through lifestyle and behavior adjustments can be a powerful preventive tool for patients with more severe forms of asthma," Tattersall said.

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