哮喘预示心血管疾病事件：动脉粥样硬化的多民族研究。
Asthma predicts cardiovascular disease events: the multi-ethnic study of atherosclerosis.
作者信息
Tattersall Matthew C, Guo Mengye, Korcarz Claudia E, Gepner Adam D, Kaufman Joel D, Liu Kiang J, Barr R Graham, Donohue Kathleen M, McClelland Robyn L, Delaney Joseph A, Stein James H
机构信息
From the Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison (M.C.T., C.E.K., A.D.G., J.H.S.); Department of Biostatistics (M.G.) and Department of Epidemiology (J.D.K., J.A.D.), University of Washington School of Public Health, Seattle; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (K.J.L.); Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University and Mailman School of Public Health, Columbia University, New York, NY (R.G.B.); and Division of Pulmonary, Department of Medicine, Allergy and Critical Care Medicine Columbia University, New York, NY (K.M.D.).
出版信息
Arterioscler Thromb Vasc Biol. 2015 Jun;35(6):1520-5. doi: 10.1161/ATVBAHA.115.305452. Epub 2015 Apr 23.
OBJECTIVES
To identify and characterize an association between persistent asthma and cardiovascular disease (CVD) risk in the Multi-Ethnic Study of Atherosclerosis (MESA).
APPROACH AND RESULTS
MESA is a longitudinal prospective study of an ethnically diverse cohort of individuals free of known CVD at its inception. The presence and severity of asthma were assessed in the MESA at examination 1. Persistent asthma was defined as asthmatics using controller medications (inhaled corticosteroids, leukotriene inhibitors, and oral corticosteroids) and intermittent asthma as asthmatics not using controller medications. Participants were followed up for a mean (SD) of 9.1 (2.8) years for development of incident CVD (coronary death, myocardial infarction, angina, stroke, and CVD death). Multivariable Cox regression models were used to assess associations of asthma and CVD. The 6792 participants were 62.2 (SD, 10.2) years old: 47% men (28% black, 22% Hispanic, and 12% Chinese). Persistent asthmatics (n=156), compared with intermittent (n=511) and nonasthmatics (n=6125), respectively, had higher C-reactive protein (1.2 [1.2] versus 0.9 [1.2] versus 0.6 [1.2] mg/L) and fibrinogen (379 [88] versus 356 [80] versus 345 [73] mg/dL) levels. Persistent asthmatics had the lowest unadjusted CVD-free survival rate of 84.1%, 95% confidence interval (78.9%-90.3%) compared with intermittent asthmatics 91.1% (88.5%-93.8%) and nonasthmatics 90.2% (89.4%-91%). Persistent asthmatics had greater risk of CVD events than nonasthmatics (hazard ratio [95% confidence interval], 1.6 [1.01-2.5]; P=0.040]), even after adjustment for age, sex, race, CVD risk factors, and antihypertensive and lipid medication use.
CONCLUSIONS
In this large multiethnic cohort, persistent asthmatics had a higher CVD event rate than nonasthmatics.
目的
在动脉粥样硬化多族裔研究（MESA）中识别并描述持续性哮喘与心血管疾病（CVD）风险之间的关联。
方法与结果
MESA是一项对初始时无已知CVD的不同种族队列进行的纵向前瞻性研究。在MESA的第1次检查时评估哮喘的存在情况和严重程度。持续性哮喘定义为使用控制药物（吸入性糖皮质激素、白三烯抑制剂和口服糖皮质激素）的哮喘患者，间歇性哮喘定义为未使用控制药物的哮喘患者。对参与者进行平均（标准差）9.1（2.8）年的随访，观察新发CVD（冠心病死亡、心肌梗死、心绞痛、中风和CVD死亡）的发生情况。使用多变量Cox回归模型评估哮喘与CVD之间的关联。6792名参与者的年龄为62.2（标准差，10.2）岁：47%为男性（28%为黑人，22%为西班牙裔，12%为华裔）。与间歇性哮喘患者（n = 511）和非哮喘患者（n = 6125）相比，持续性哮喘患者（n = 156）的C反应蛋白水平更高（分别为1.2 [1.2] 与0.9 [1.2] 与0.6 [1.2] mg/L），纤维蛋白原水平也更高（分别为379 [88] 与356 [80] 与345 [73] mg/dL）。持续性哮喘患者未经调整的无CVD生存率最低，为84.1%，95%置信区间为（78.9% - 90.3%），而间歇性哮喘患者为91.1%（88.5% - 93.8%），非哮喘患者为90.2%（89.4% - 91%）。即使在调整了年龄、性别、种族、CVD风险因素以及抗高血压和降脂药物使用情况后，持续性哮喘患者发生CVD事件的风险仍高于非哮喘患者（风险比[95%置信区间]，1.6 [1.01 - 2.5]；P = 0.040）。
结论
在这个大型多族裔队列中，持续性哮喘患者的CVD事件发生率高于非哮喘患者。
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