Childhood Asthma Linked With Increased Left Ventricular Mass In Adulthood

A prospective study published in JACC Heart Failure identified an association between a history of asthma from childhood and increased left ventricular (LV) mass later in life.¹

The prevalence of LV hypertrophy in the general population is approximately 14.9% in men and 9.1% in women.² In individuals with hypertension, the prevalence is as high 41%.³ Results of previous studies show that increased LV mass indexed to height (LVMI) is an independent risk factor for mortality and cardiovascular events.^4,5 In addition, recent findings suggest an association between increased LV mass and chronic inflammation.^6,7

Over the past decade, there has been an increase in the prevalence of asthma, a chronic inflammatory disorder that now affects an estimated 8.6% of children⁸ and 7.4% of adults.⁹ Limited findings from studies with adult participants demonstrate a link between asthma and an elevated risk for death, stroke, and coronary heart disease.

The current researchers noted the need for a prospective investigation into the association between a history of asthma from childhood and LV mass in adulthood. To that end, they analyzed data from the ongoing Bogalusa Heart Study, which was established in 1973 to investigate “the natural history of CV risk factors and their impact on vascular and metabolic changes throughout the life span.” The cohort is 65% white and 35% black.¹

The present analysis included 1118 participants with a baseline history of self-reported asthma since childhood, and the average follow-up period was 10.4±7.5 years. After adjustment for sex, race, age, antihypertensive medication, smoking status, heart rate, and systolic blood pressure (SBP), the results revealed a greater LV mass (167.6 vs 156.9; P =.01) and LVMI (40.7 vs 37.7; P <.01) in participants with a history of childhood asthma compared with participants without said history.¹

The between-group difference in LVMI remained significant even after further adjustment for body mass index (39.0 vs 37.1; P =.03) and high-sensitivity C-reactive protein (38.4 vs 36.6; P =.04). Significant interactions were also observed between SBP and asthma on LV mass and LVMI (both P for interaction <.01). Participants with prehypertension and hypertension showed stronger links between asthma and both LV mass and LVMI compared with patients with normal SBP (regression coefficient, 39.5 vs 2.3 and 9.0 vs 0.9, respectively).¹

An editorial published in the same journal issue cited several limitations of the study.¹⁰ One is that the “current data do not exclude the possibility that asthma is a comorbidity of CVD [cardiovascular disease], and perhaps is a fellow traveler with CVD severity rather than being a cause of CVD,” John S. Gottdiener, MD, from the division of cardiology at the University of Maryland Medical Center in Baltimore, wrote.

Dr Gottdiener also noted that there may be connections between LV mass and asthma severity or the use of beta agonists and corticosteroids, which have implications for participant selection.

Although additional studies are needed, the researchers concluded these “data suggest that aggressive lifestyle modifications or even pharmacological treatment may be applied to people with a history of asthma, especially those also affected by high blood pressure, to lower CV risk.” 

References

1. Sun D, Wang T, Heianza Y, et al. A history of asthma from childhood and left ventricular mass in asymptomatic young adults. The Bogalusa Heart Study. JACC: Heart Failure. 2017;5(7):497-504. doi:10.1016/j.jchf.2017.03.009
2. Schirmer H, Lunde P, Rasmussen K. Prevalence of left ventricular hypertrophy in a general population: the Tromsø study. Eur Heart J. 1999;20(6):429-438. doi:10.1053/euhj.1998.1314
3. Cuspidi C, Sala C, Negri F, Mancia G, Morganti A. Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies. J Hum Hypertens. 2012;26(6):343-349. doi:10.1038/jhh.2011.104
4. Desai CS, Bartz TM, Gottdiener JS, LloydJones DM, Gardin JM. Usefulness of left ventricular mass and geometry for determining 10-year prediction of cardiovascular disease in adults aged 65 years (from the Cardiovascular Health Study). Am J Cardiol. 2016;118(5):684-690. doi:10.1016/j.amjcard.2016.06.016
5. Bluemke DA, Kronmal RA, Lima JA, et al. The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) study. J Am Coll Cardiol. 2008;52(25):2148-2155. doi:10.1016/j.jacc.2008.09.014
6. Kubota T, McTiernan CF, Frye CS, et al. Dilated cardiomyopathy in transgenic mice with cardiacspecific overexpression of tumor necrosis factoralpha. Cir Res. 1997;81(4):627-635. doi:10.1161/01.RES.81.4.627
7. Masiha S, Sundström J, Lind L. Inflammatory markers are associated with left ventricular hypertrophy and diastolic dysfunction in a population-based sample of elderly men and women. J Hum Hypertens. 2013;27(1):13-17. doi:10.1038/jhh.2011.113
8. Centers for Disease Control and Prevention (CDC). Table A-2a. Age-adjusted percentages (with standard errors) of ever having asthma and still having asthma for children under 18 years, by selected characteristics: United States; 2014. https://ftp.cdc.gov/pub/health_Statistics/nchs/NHIS/SHS/2014_SHS_Table_C-1.pdf. Accessed June 27, 2017.
9. Centers for Disease Control and Prevention (CDC). Table A-2a. Age-adjusted percentages (with standard errors) of selected respiratory diseases among adults aged 18 and over, by selected characteristics: United States; 2014.  https://ftp.cdc.gov/pub/health_statistics/NCHS/ NHIS/SHS/2014_SHS_Table_A-2.pdf. Accessed June 27, 2017.
10. Gottdiener JS. Intersection of 2 epidemics: asthma and cardiovascular disease. JACC: Heart Failure. 2017;5(7):505-506. doi:10.1016/j.jchf.2017.05.003