Persistent Asthma Associated With Cardiovascular Risk Factor

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An analysis of data from the Multi-Ethnic Study of Atherosclerosis suggests that adults with asthma may have higher levels of carotid artery plaque, which is associated with greater risk of heart attack or stroke.

Adults with asthma may be at higher risk of heart attack or stroke due to an excess buildup of plague in the carotid arteries, recent study findings suggest. Compared with participants without asthma or with intermittent asthma, those with persistent asthma also had higher levels of inflammatory biomarkers.

The analysis, published in the Journal of American Heart Association, found that excess buildup of plaque in the carotid arteries was present in 67% of the study’s participants with persistent asthma, a percentage significantly higher than in participants without asthma (50.5%) or participants with intermittent asthma (49.5%).

“Many physicians and patients don’t realize that asthmatic airway inflammation may affect the arteries, so for people with persistent asthma, addressing risk factors for cardiovascular disease may be really helpful,” said lead study author Matthew C. Tattersall, DO, MS, assistant professor in the Department of Medicine at the University of Wisconsin in Madison, in a news release.

The data used for this analysis came from participants enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). Participants were recruited between 2000 and 2002 from research centers in located in Baltimore; Chicago; Los Angeles County; New York City; Forsyth County, North Carolina; and St Paul, Minnesota. At the time of enrollment, all participants were free of cardiovascular disease. Research following these participants is ongoing.

From the MESA data, 5029 adults were included in this analysis. These participants had baseline data on risk factors for cardiovascular disease and had carotid ultrasound data.


Participants were ethnically and racially diverse, with 26% of adults identifying as African American, 23% identifying as Hispanic, and 12% identifying as Chinese. Additionally, 53% of the group was female.

Participants were categorized into subgroups, which consisted of those with persistent asthma (n = 109), defined as using medication daily to control asthma symptoms; those with intermittent asthma (n = 388), defined as having a history of asthma but not using daily medications; and those without asthma (n = 4532).

The researchers used carotid ultrasonography to define the presence or burden of plaque in both the left and right walls of the carotid arteries, using a total plaque score (TPS) that indicates the number of segments with carotid plaque, from 0 to 12. Blood measurements of the inflammatory biomarkers IL-6 and C-reactive protein (CRP) were also recorded.

The authors found that carotid plaque was present in about half of participants without asthma or with intermittent asthma, but about two-thirds of those with persistent asthma (50.5%, 49.5%, and 67.0%, respectively). Those with persistent asthma also had the highest mean (SD) TPS at 2.08 (2.35) compared with 1.29 (1.80) in those without asthma and 1.25 (1.76) in those with intermittent asthma (P < .003).

After adjusting for age, sex, race, weight, and other factors such as taking prescription medication or smoking, participants with persistent asthma had nearly twice as high odds of having plaque in the carotid arteries as those without asthma (odds ratio, 1.83; 95% CI, 1.21-2.76; P < .001).

When the investigators accounted for IL-6 and CRP, the association between persistent asthma and carotid plaque remained.

“Participants who have persistent asthma had elevated levels of inflammation in their blood, even though their asthma was treated with medication, which highlights the inflammatory features of asthma. We know that higher levels of inflammation lead to negative effects on the cardiovascular system,” said Tattersall.

However, because the study was an observational analysis, findings indicate only an association between asthma and cardiovascular disease, rather than a cause and effect.

“The most important message from our findings is that more significant forms of asthma are associated with more cardiovascular disease and cardiovascular events,” said Tattersall.


Tattersall MC, Dasiewicz AS, McClelland RL, et al. Persistent asthma is associated with carotid plaque in MESA. J Am Heart Assoc. 2022;11:e026644. doi:10.1161/jaha.122.026644