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Stroke risk: Persistent asthma may cause buildup of artery plaque

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Share on PinterestNew research shows that persistent asthma causes inflammation and artery plaque buildup, increasing the risk of heart attack or stroke. Fajrul Islam/Getty Images

Asthma is a respiratory condition that impacts an estimated 262 million people worldwide. It is characterized by inflammation of the small airways, leading to symptoms including shortness of breath, coughing, and wheezing.

Research from 2016 suggests that asthma may play a role in atherosclerosis — the buildup of plaque, or fatty deposits, on artery walls. Still, the associations between asthma and heart disease are unclear.

Yet a 2020 study found that people with persistent asthma may have up to 1.5 times higher risk of developing atrial fibrillation (AFib) than those without the respiratory condition.

Recently, a new study found that participants with persistent asthma have a greater likelihood of plaque buildup in their carotid arteries than those without asthma.

The findings persisted even after the scientists adjusted for demographic and lifestyle factors. Moreover, those with persistent asthma also had higher levels of inflammatory markers in their blood.

The study appears in the Journal of the American Heart Association.

For the study, scientists hypothesized that persistent asthma could be associated with an increased buildup of plaque in the carotid arteries — the large vessels that supply blood to the brain.

Research from 2021 suggests that plaque buildup in these arteries strongly predicts future cardiovascular events.

To investigate their hypothesis, the scientists collected data from participants in the Multi-Ethnic Study of Atherosclerosis (MESA) study. The MESA study includes a large, ethnically diverse cohort of 6,814 adults who did not have cardiovascular disease at the time of enrollment.

The research team examined the data from 5,029 adults in the MESA who had cardiovascular disease risk factors and carotid ultrasound data in their records.

At the start of the MESA study, participants also had blood levels of interleukin-6 (IL-6) and C-reactive protein (CRP) measurements taken. IL-6 and CRP are inflammatory markers in the blood.

The scientists divided the participants into either persistent asthma, intermittent asthma, or no asthma groups.

The researchers defined persistent asthma as asthma requiring daily use of controlling medications. Participants in the intermittent group had a history of asthma but did not use controlling medications daily.

Among the participants, 109 had persistent asthma, 388 had intermittent asthma, and the remaining 4,532 did not have the condition.

After analyzing the data, the researchers discovered several key findings.

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

After the scientists adjusted the data for factors including prescription medication use, age, race, sex, other health conditions, and smoking, they found that individuals with persistent asthma had a significantly higher risk of having plaque in their carotid arteries than those who did not have asthma.

Additionally, inflammatory markers in the blood were slightly higher in participants with persistent asthma. For example, IL-6 measurements in the persistent asthma group averaged 1.89 pg/mL. In contrast, those who did not have asthma had average IL-6 measurements of 1.52 pg/mL.

Moreover, CRP measurements averaged 6.49 mg/L in the persistent asthma group and 3.61 mg/L in participants without asthma.

However, accounting for the inflammatory biomarkers did not lessen the association between persistent asthma and carotid artery plaque.

In a press release, lead study author Matthew C. Tattersall, DO, MS, an assistant professor in the department of medicine at the University of Wisconsin, Madison, said:

"This analysis tells us that the increased risk for carotid plaques among people with persistent asthma is probably affected by multiple factors. 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."

According to the study authors, the discovery underscores the need for more research into the shared mechanisms of atherosclerotic cardiovascular disease (ASCVD) and asthma.

After reviewing the research, Dr. Russell Luepker, MS, heart health and cardiovascular epidemiology and prevention expert and professor emeritus at the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, agreed that more investigations are needed.

Dr. Luepker told Medical News Today that the study does not imply causation as recognized by the authors. He said the following questions cannot be answered:

"[The research team] hoped that biomarkers for inflammation (CRP, IL-6) would provide evidence for a connection, but they did not, leading to the conclusion that this was multifactor with the other factors unknown. Other than the association with severe asthma, the relationships are modest."

- Dr. Russell Luepker, MS

Dr. Praveen Bhatia, MBBS, FRCP, a consultant physician in respiratory and general Medicine in Stockport in the United Kingdom and specialist clinical advisor to MedCourse, told MNT:

"Asthma carries with it a significant risk of cardiovascular disease if not properly managed, including heart attacks, high blood pressure, and atrial fibrillation. This is likely because asthma causes inflammation in the body which can then go on to cause damage to the heart."

Dr. Bhatia suggested that for people with asthma, the best way to mitigate these risks is through effective asthma management, along with eating healthy and exercising.

Dr. Bhatia suggested three essential methods for managing asthma. These include:

Dr. Bhatia added that the most effective way to manage asthma is to take these medications regularly and at the same time each day.

He also noted that while taking these medications, a person should also keep track of the frequency of asthma symptoms.

"If you are getting symptoms more than four times in a week, it's worth talking [with] your [healthcare professional] to see whether you need stronger medication," Dr. Bhatia said.

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