Wang Zuoxiang, Qian Xifeng, Lv Junxing, Li Ziang, Yin Zheng, Wang Can, Zhao Sheng, Gao Xiaojin, Wu Yongjian
Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China.
Department of Cardiology, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Beijing, China
Heart. 2025 Aug 19. doi: 10.1136/heartjnl-2024-325575.
Asthma has been associated with the development and progression of various cardiovascular diseases but its relationship with degenerative valvular heart disease (VHD) remains unclear. This study investigated the association between asthma and incident degenerative VHD, including aortic stenosis (AS), aortic regurgitation (AR), mitral regurgitation (MR) and pulmonary regurgitation (PR).
We analysed 483 735 participants from the UK Biobank (median age 56.5 years; 45.2% male) who were free of VHD at baseline. Asthma status was self-reported at recruitment. Incident VHD was ascertained through hospital admission and mortality records using International Classification of Diseases, Tenth Revision codes. Cox proportional hazards models were used to estimate HRs and 95% CIs for each VHD subtype, adjusting for demographic, lifestyle and clinical covariates. Sensitivity analyses accounted for asthma medications, duration of asthma and competing risks.
Over a median follow-up of 13.8 years, 5388 participants developed AS, 2650 AR, 6088 MR and 821 PR. Asthma was associated with increased risk of AS (HR 1.31; 95% CI 1.21 to 1.41), AR (HR 1.24; 95% CI 1.11 to 1.39), MR (HR 1.19; 95% CI 1.10 to 1.28) and PR (HR 1.34; 95% CI 1.10 to 1.62). The association with AR was attenuated after adjusting for asthma medications (HR 1.12; 95% CI 0.97 to 1.30). Results were robust across multiple sensitivity analyses, including adjustment for asthma duration and exclusion of participants with pre-existing cardiovascular disease.
Asthma is independently associated with a modestly increased risk of several degenerative VHDs, particularly aortic and mitral valve diseases. These findings suggest a potential shared inflammatory pathway and highlight the need for heightened cardiovascular surveillance in individuals with asthma.
哮喘与多种心血管疾病的发生和发展有关，但其与退行性心脏瓣膜病（VHD）的关系仍不明确。本研究调查了哮喘与新发退行性VHD之间的关联，包括主动脉瓣狭窄（AS）、主动脉瓣反流（AR）、二尖瓣反流（MR）和肺动脉瓣反流（PR）。
我们分析了英国生物银行的483735名参与者（中位年龄56.5岁；45.2%为男性），他们在基线时无VHD。哮喘状态在招募时通过自我报告获得。新发VHD通过使用国际疾病分类第十版编码的住院和死亡记录确定。采用Cox比例风险模型估计每种VHD亚型的HR和95%CI，并对人口统计学、生活方式和临床协变量进行调整。敏感性分析考虑了哮喘药物、哮喘持续时间和竞争风险。
在中位随访13.8年期间，5388名参与者发生了AS，2650名发生了AR，6088名发生了MR，821名发生了PR。哮喘与AS风险增加相关（HR 1.31；95%CI 1.21至1.41）、AR（HR 1.24；95%CI 1.11至1.39）、MR（HR 1.19；95%CI 1.10至1.28）和PR（HR 1.34；95%CI 1.10至1.62）。在调整哮喘药物后，与AR的关联减弱（HR 1.12；95%CI 0.97至1.30）。在包括调整哮喘持续时间和排除已有心血管疾病的参与者在内的多项敏感性分析中，结果均稳健。
哮喘与几种退行性VHD风险适度增加独立相关，尤其是主动脉瓣和二尖瓣疾病。这些发现提示了潜在的共同炎症途径，并强调了对哮喘患者加强心血管监测的必要性。
