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Recent asthma may confer elevated risk for AAA development, rupture
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Adults aged at least 50 years who have had recent asthma activity may be at elevated risk for the development or rupture of abdominal aortic aneurysm, according to new findings.
Previous research in mice produced a link between asthma and abdominal aortic aneurysm (AAA), so Guo-Ping Shi, ScD, and colleagues investigated whether the link also occurs in humans. They analyzed medical records from 15,942 patients aged 50 years or older with AAA and from 18,749 men aged 65 to 74 years without known AAA.
Guo-Ping Shi
They performed logistic regression models to determine whether asthma is associated with risk for ruptured AAA in the cohort of patients with existing AAA, and whether asthma is associated with risk for AAA detection upon screening in the cohort of patients without known AAA.
Asthma and AAA rupture
In the cohort with existing AAA, diagnosis of asthma within 1 year (crude OR = 1.6; 95% CI, 1.03-2.5) and within 6 months (crude OR = 2.12; 95% CI, 1.28-3.51) was associated with increased risk for AAA rupture, according to the researchers.
After adjustment for AAA comorbidities, elevated risk for AAA rupture remained in those diagnosed with asthma within 6 months (OR = 2.06; 95% CI, 1.21-3.53), and there was a trend toward significance in those diagnosed within 1 year (OR = 1.51; 95% CI, 0.94-2.41), they found.
The elevated risk was not found in those who had ever been diagnosed with asthma (crude OR = 1.08; 95% CI, 0.9-1.3; adjusted OR = 1.02; 95% CI, 0.84-1.24), Shi, biochemist at Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote.
Use of bronchodilators at any point in an individual with AAA’s life was associated with increased risk for AAA rupture (crude OR = 1.1; 95% CI, 1.02-1.19; adjusted OR, 1.1; 95% CI, 1.01-1.19), and the risk increased the closer to the index date a bronchodilator was used, according to the researchers.
Those with AAA who had ever taken selective beta-2-adrenergic receptor agonists (adjusted OR = 1.11; 95% CI, 1.02-1.21), anticholinergics (adjusted OR = 1.26; 95% CI, 1.09-1.45) or theophylline (adjusted OR = 1.24; 95% CI, 1.03-1.49) had elevated risk for AAA rupture, as did those who had taken glucocorticoids within 1 year (adjusted OR = 1.23; 95% CI, 1.07-1.41), Shi and colleagues wrote.
Asthma and AAA development
In the cohort of men without known AAA at baseline, use of a bronchodilator was associated with elevated risk for developing AAA even after adjustment for smoking and other risk factors (OR = 1.46; 95% CI, 1.1-1.94), they found.
“Older patients, especially men, with a recent asthma diagnosis should be checked for signs of aortic aneurysm,” Shi said in a press release. “In addition, patients with a diagnosed aneurysm who later develop asthma should also be monitored for changes in the size and strength of the aorta.”
One explanation for the link could be immunoglobin E (IgE), Shi said. “IgE is one of the main players,” he stated in the release. “Our study suggests that asthmatic patients have higher levels of IgE, which can activate many cells, including inflammatory cells and vascular cells that promote aneurysm and cause aortic rupture.” – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.
Editor's Note: This article was updated on Jan. 7, 2021 to correct the credentials for Dr. Shi. The Editors regret the error.
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