Review: Asthma, related allergies can be CVD risk factors
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Asthma and related allergies are sometimes risk factors for CVD, and the two conditions share common mechanisms, according to a review.
The review published in Nature Cardiovascular Research also identified classes of asthma medications that may exacerbate CVD risk as well as those that may protect against it.
“Asthma and allergy are a big category of disease, and cardiovascular disease is another big category of disease. Many people realize that obesity is associated with asthma and certain allergies, but not many people know that asthma is associated with cardiovascular disease, despite there being clinical and basic science studies on the topic,” Guo-Ping Shi, ScD, associate professor of medicine at Harvard Medical School and biochemist in cardiovascular medicine at Brigham and Women’s Hospital, told Healio. “We have been studying this association for 20 years. It is time for us to emphasize and let the public know that there is such an association. That is the main rationale for writing this paper.”
Asthma and CVD risks
The review discusses studies that have shown allergic asthma is a risk for CVD, CHD, aortic diseases, peripheral artery disease, pulmonary embolism, pulmonary hypertension, right ventricular dysfunction, atrial fibrillation, cardiac hypertrophy and hypertension; and that asthma-relevant allergies can also correlate with CVD.
Shi and colleagues also wrote that asthma and CVD share common mechanisms, and that some classes of asthma drugs worsen risk for CVD while others reduce CVD risk.
“Allergies/asthma and CVD share similar mechanisms, mainly angiogenesis and obesity. People may know about those already, as well as coagulation activation and inflammation,” Shi told Healio. “But they may not be familiar with shared mechanisms such as eosinophils, mast cells and immunoglobin E (IgE). We have been watching those for the past 20 years and have published several seminal articles on them to show people that mast cells and IgE are important pathogens to CVD. But those two are also involved in the lungs and affect patients with asthma and allergies. People with allergies have a lot of IgE and mast cells accumulated. Those cells and molecules play similar roles in in the cardiovascular system.”
Importantly, he said, eosinophils and T helper 2 cells are pathogenic in the lungs but protective in the heart.
Appropriate drugs to use
The paper emphasizes that doctors should pay attention to whether patients with asthma or related allergies have CV risk factors, and to which classes of asthma drugs are appropriate to administer to patients at high CV risk.
“The article has two tables that list several categories of common currently used anti-asthma drugs,” Shi told Healio. “Some of these drugs may increase the risk of cardiovascular disease. Beta-2 agonists are very common asthma drugs, and many studies show that these drugs can increase risk of cardiovascular disease, including acute MI and stroke. These drugs must be used with caution. Anticholinergic agents are much safer and can be used for patients with asthma and also decrease the risk for cardiovascular disease. When doctors see those tables, it will help them figure out which ones to use.”
Also of note, he said, oral or IV corticosteroids may be harmful to the heart, but inhaled corticosteroids are not.
In addition, he said, “Leukotriene modifiers and antibodies against IgE and interleukin-5 have been widely used for asthma and can benefit patients with CV risk factors.”
Shi told Healio that his team has received NIH grants to study the function of eosinophils in the heart and vasculature, and why they behave differently there from in the lungs.
For more information:
Guo-Ping Shi, ScD, can be reached at gshi@bwh.harvard.edu.
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