Cardiovascular disease risk associated with asthma and respiratory morbidity might be mediated by short-acting β2-agonists

Sarah L. Appleton, Richard E. Ruffin, David H. Wilson, Anne W. Taylor, Robert J. Adams

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35 Citations (Scopus)


Background: Studies examining the asthma-related risks of cardiovascular disease (CVD) events have generally used selected samples or did not control for the effects of β2-agonist use, itself associated with CVD events. Objectives: We assessed the relationship between incident CVD/stroke and asthma and the effect of atopy while controlling for β2-agonist use in a representative adult population cohort free of CVD at baseline. Methods: The North West Adelaide Health Study (stage 1, n = 3812; stage 2, n = 3113) assessed spirometry, anthropometry, atopy, blood pressure, and lipid levels. Questionnaires assessed doctor-diagnosed asthma and CVD (myocardial infarction and angina)/stroke, smoking status, and demographics. Asthma was defined by self-report or FEV1 reversibility. Current short- and long-acting β2-agonist use was identified at follow-up. Results: Results are expressed as odds ratios (ORs) and 95% CIs. By using multivariable logistic regression, after adjustment for risk factors, in female subjects incident CVD/stroke events were associated with asthma (OR, 3.24; 95% CI, 1.55-6.78), with no effect modification by atopy (P for interaction = .61), and with as-required short-acting β2-agonist use (OR, 2.66; 95% CI, 1.06-6.61). In male subjects events were associated with daily cough/sputum (OR, 1.92; 95% CI, 1.05-3.50) and FEV1 of less than 80% of predicted value but an FEV1/forced vital capacity ratio of greater than 0.70 (OR, 2.15; 95% CI, 0.91-5.09; P = .08). Although few CVD/stroke events occurred in male subjects with asthma, a significant interaction with atopic status was found (P = .05). Conclusions: Studies are required to elucidate how asthma exposes older women to excess macrovascular risk and prospectively determine the short-acting β2-agonist-related risk in persons without existing CVD. CVD risk in relation to atopic status of asthma also requires further investigation.

Original languageEnglish
Pages (from-to)124-130.e1
JournalJournal of Allergy and Clinical Immunology
Issue number1
Publication statusPublished or Issued - Jan 2009
Externally publishedYes


  • Adrenergic β-agonists
  • asthma
  • cardiovascular system
  • epidemiology
  • lung diseases
  • obstructive

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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