Is allergic asthma related to cardiovascular disease?

Asthma and related allergies affect the prevalence, incidence and progression of cardiovascular disease. IgE, mast cells, eosinophils, and their departition products play different roles in these diseases. (Liu Tianxiao)

The authors report in the form of a map that multiple studies have demonstrated that asthma, asthma medications, and asthma-related allergies are risk factors for CVD. (Liu Tianxiao)

When we think of cardiovascular disease (CVD), we mostly think of risk factors such as high blood pressure, high cholesterol, obesity and diabetes. But there is growing evidence in basic and clinical studies that another common condition that may be associated with CVD risk is allergic asthma.

On May 16, Nature-Cardiovascular Research published a review article by Shi Guoping, professor at Harvard Medical School, and Guo Junli, director of the Hainan Provincial Key Laboratory of Tropical Cardiovascular Disease Research, “Allergic asthma is a risk factor for human cardiovascular disease.”

The authors analyze and sort out how allergic asthma and other related allergies affect the prevalence, incidence and progression of CVD, and their inverse relationships, and also list a series of commonly used anti-asthma drugs and the risk relationship between CVD, which will have a guiding effect on the clinical diagnosis and treatment of allergic asthma and CVD.

There may be a co-pathogenic mechanism

“Many people think that asthma is a lung disease, but in fact there is an important pathological and etiological link between asthma and cardiovascular disease, such as coronary heart disease, high blood pressure, etc.” Shi Guoping, the corresponding author of the article, said that when he studied for a doctorate at Harvard University, he specialized in respiratory biology, and then studied and worked in the Department of Pulmonary and Intensive Care Medicine at The Bregan Women’s Hospital affiliated with Harvard Medical School for more than 10 years, and then moved to the cardiovascular department of the hospital to open up a new research direction.

The accumulation of more than 30 years of study and work in these two fields has made him pay attention to the association between allergic asthma and CVD. “The evidence we have seen from clinical trials and underlying studies suggests that allergic asthma is an important risk factor that CVD clinicians and patients need to be aware of when considering individual risk, and is often overlooked by relevant patients and even physicians.”

Therefore, the journal Nature-Cardiovascular Research specifically invited Shi Guoping to complete this review paper. In addition to Guo Junli, Shi Guoping also invited Peter Libby, former director of the Department of Cardiology at Blegan Women’s Hospital of Harvard Medical School and president of the International Association for Coronary Heart Disease, and Bruce D. Levy, director of the Department of Pulmonary and Intensive Care Medicine at Bregen Women’s Hospital of Harvard Medical School, to participate in the writing and proofreading of the article.

They point out in the article that previous studies have shown that allergic asthma and related allergies are important risk factors for CVD, including coronary heart disease, aortic disease, peripheral arterial disease, pulmonary embolism, right ventricular dysfunction, stroke, atrial fibrillation, heart failure, and hypertension.

Clinical studies have shown that many anti-asthma therapies affect the risk of CVD. Therefore, allergic asthma and CVD may have a common pathogenic mechanism. At the same time, anti-asthma drugs have the potential to be effective in the treatment of certain cardiovascular diseases.

Other allergic reactions are also important CVD risk factors

The authors also specifically combed through clinical studies of CVD and related allergic diseases, such as allergic rhinitis caused by pollen and other environmental factors, specific dermatitis (i.e., allergic eczema), and severe food and drug allergies.

Shi Guoping told China Science Daily: “These observations show that in addition to asthma, allergic reactions are also important risk factors for CVD. ”

They analyzed preclinical models and laboratory findings that suggest that mast cells, eosinophils, inflammatory cytokines, and immunoglobulins (IgE), which may accumulate in the lungs, heart, and vascular systems, all affect asthma and CVD onset and lesions to varying degrees.

“There’s an old Chinese saying: Ten fat and nine breaths.” Mast cells are one of the common white blood cells activated by circulating IgE in the body of obese, asthma, or allergy patients, and Shi Guoping believes that mast cells and IgE are two important components of allergic asthma and CVD after combing through decades of relevant research, with similar pathogenic mechanisms.

However, certain cell types may play different roles in asthma and CVD. For example, basic studies have shown that eosinophils play a good protective role in CVD against the heart and blood vessels, but clinical studies have shown that such cells promote allergic asthma. These anomalies will help follow-up researchers better understand the pathological effects of different cell types, and further refine the treatment, management, and risk assessment of these common diseases.

Form 1 (courtesy of respondents)

Form 2 (provided by respondents)

Hope to play a role in the clinic

Shi Guoping particularly valued the effects of different anti-allergy drugs and asthma drugs listed in the article on CVD (see Tables 1 and 2).

For example, it is commonly used to treat acute asthma attacks” Rescue inhaler” Inhalation of salbutamol appears to reduce the risk of CVD.

Corticosteroids such as prednisone or intravenously may increase the risk of CVD, but the risk of CVD is reduced by inhalation of spray corticosteroids such as fluticasone propionate and budesonide.

Leukotriene modulators such as montelukast can reduce inflammation, lipid levels, and cardiovascular events.

Anti-asthma antibodies such as omarizumab had mixed results—one study found an increased risk of CVD, while other studies showed a reduced or no effect.

“I very much hope that the clinical data analysis in the article will be helpful to the doctor’s clinical judgment and the patient’s choice of drugs.” Shi Guoping said that all the research is to benefit the treatment and benefit the patient.

He revealed that based on these previous studies, his research group is seeking a breakthrough in the wonderful interaction between eosinophils and allergic asthma and CVD. (Source: China Science Daily Zhang Nan)

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