Asthma and incident cardiovascular disease: The Atherosclerosis Risk in Communities Study

Background: A possible association between asthma and cardiovascular disease has been described in several exploratory studies. Methods: The association of self-reported, doctor diagnosed asthma and incident cardiovascular disease was examined in a biracial cohort of 45 - 64 year old adults (N = 13501) followed over 14 years. Results: Compared with never having asthma, the multivariate adjusted hazard ratio (HR) of stroke (n = 438) was 1.50 (95% CI 1.04 to 2.15) for a baseline report of ever having asthma ( prevalence 5.2%) and 1.55 ( 95% CI 0.95 to 2.52) for current asthma ( prevalence 2.7%). The relative risk of stroke was 1.43 ( 95% CI 1.03 to 1.98) using a time dependent analysis incorporating follow up reports of asthma. Participants reporting wheeze attacks with shortness of breath also had greater risk for stroke ( HR = 1.56, 95% CI 1.18 to 2.06) than participants without these symptoms. The multivariate adjusted relative risk of coronary heart disease ( n = 1349) was 0.87 ( 95% CI 0.66 to 1.14) for ever having asthma, 0.69 ( 95% CI 0.46 to 1.05) for current asthma at baseline, and 0.88 ( 95% CI 0.69 to 1.11) using the time dependent analysis. Conclusions: Asthma may be an independent risk factor for incident stroke but not coronary heart disease in middle aged adults. This finding warrants replication and may motivate a search for possible mechanisms that link asthma and stroke.