Does asthma hasten plaque buildup in arteries and raise heart disease risk?

Of late numerous investigations have been done on the relationship between asthma attacks and cardiovascular diseases, according to Dr Nishith Chandra, Principal Director, Interventional Cardiology, Fortis Escorts, New Delhi. “Asthma is a disease of chronic inflammation of small airways. So the development of elevated cardio-vascular disease (CVD) risk and chronic inflammatory illness are thought to be related. Chronic inflammation of the airways may lead to systemic inflammation and make people more susceptible to vascular disorders. High-sensitivity C-reactive protein (Hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-a), interleukin-8 (IL-8), and fibrinogen are well-established inflammatory biomarkers that are enhanced in atherogenesis and are also known to be up in asthmatics,” he says.

Dr Chandra says asthmatic patients show symptoms of increased coagulation, compromised anti-coagulant protein C system functioning, attenuated fibrinolysis and elevated platelet activation. All these factors increase the risk of heart attacks.

Sometimes the risk depends on other factors as well. “Different studies show a positive correlation between the incidence of CVD and asthma. This correlation varies by gender, smoking status, asthma severity and age of asthma onset. Women with asthma have a higher risk of developing atherosclerosis. To fully comprehend why asthmatic women may have a higher risk of developing CVD than asthmatic men, more research is required. Maybe women are less active, gain more weight, develop obesity and have metabolic diseases,” Dr Chandra says.

Dr Avi Kumar, Senior Consultant. Pulmonology, Fortis Escorts, says there is now enough evidence that shows asthma to be a pan-inflammatory disease. “Patients with asthma demonstrate an increased risk for cardiovascular complications simply because their lung functioning is impaired. Previous studies have confirmed the association of bronchial asthma with vessel changes. However, no clear patho mechanisms have been elaborated underlying asthma-associated atherosclerosis but growing evidence suggests increased inflammation, oxidation, and activation of blood platelets. Asthma has already been described to be a risk factor for stroke and heart disease. Patients with impaired lung infections are more liable to develop cardiovascular complications. There is increasing evidence of the association of adult onset asthma with an augmented carotid intima-media thickness among women. Recent approaches have shown elevated levels of fibrinogen, lipoprotein (a), thrombocyte, and eosinophil count in asthmatics which are associated with increased cardiovascular events. Persistent asthma patients have 1.5 times risk for atrial fibrillation,” he adds.

The Multi-Ethnic Study of Atherosclerosis (MESA) collected data from 6,814 adults who did not have cardiovascular disease at the time of enrollment. Among the participants, 109 had persistent asthma, 388 had intermittent asthma, and the remaining 4,532 did not have the condition.

Specifically, 67 per cent of participants with persistent asthma had an average of two plaques in their carotid arteries. In contrast, 49.5 per cent of people with intermittent asthma and 50.5 per cent without asthma had about one carotid plaque.