Association of Persistent Asthma and Carotid Plaque
In this video, Matthew C. Tattersall, DO, MS, discusses persistent asthma and its association with carotid plaque burden, which is a strong predictor of atherosclerotic cardiovascular disease events, in the Multi-Ethnic Study of Atherosclerosis (MESA).
Additional Resource:
Tattersall MC, Dasiewicz AS, McClelland RL, Jarjour NN, Korcarz CE, Mitchell CC, Esnault S, Szklo M, Stein JH. Persistent asthma Is associated with carotid plaque in MESA. J Am Heart Assoc. 2022;11(23):e026644. doi:10.1161/JAHA.122.026644
Matthew C. Tattersall, DO, MS, is an assistant professor of medicine in the Division of Cardiovascular Medicine in the Department of Medicine at the University of Wisconsin hospitals and clinics (Madison, WI).
TRANSCRIPTION:
Matthew Tattersall, DO, MS: My name is Matthew Tattersall. I'm an assistant professor of medicine in the Division of Cardiovascular Medicine in the Department of Medicine at the University of Wisconsin hospitals and clinics.
Consultant360: Please provide an overview of your study “Persistent Asthma Is Associated With Carotid Plaque in MESA.”
Matthew Tattersall, DO, MS: The research study that we published in The Journal of the American Heart Association was investigating how asthma may increase the risk of cardiovascular disease. Asthma affects more than 25 million individuals in the United States and cardiovascular disease, as you know, is the leading cause of death in the United States. In the multi-ethnic study of atherosclerosis, which is a National Institutes of Health-funded cohort study, we found three main findings. The first finding is that participants with persistent asthma had two-fold higher odds of having carotid plaque in their carotid arteries compared with those without asthma. Second, persistent asthmatic participants had more carotid plaque burden or buildup compared with participants without asthma. Finally, despite being treated for their asthma, the individuals with persistent asthma had higher markers of inflammation in their blood. Specifically, at interleukin six or IL-6.
C360: What was the impetus for this study?
Dr Tattersall: This is a long-standing area of research for us, and so this study builds off of some of our prior studies. We've previously looked at persistent asthma and more severe forms of asthma phenotypes in the past in other cohorts, specifically in the multi-ethnic study of atherosclerosis or MESA, as well as the Wisconsin Sleep Cohort. And time and time again, we find that specific phenotypes or more significant amounts of asthma are strongly associated with increased cardiovascular disease events. The problem is we had the events, but we didn't have the vessel level or kind of foundation for what led to those cardiovascular events. So, having this study where we observed higher amounts of carotid plaque kind of ties these findings together.
C360: How does this study fill the gaps in the current research on persistent asthma and atherosclerotic cardiovascular disease?
Dr Tattersall: I think it, in part and partial to what we had just discussed, I think that this study looks at a different aspect, which is the formation of carotid plaque. Carotid plaque is the strongest predictor of future cardiovascular events and is a subclinical measure. So, what this study does, is links some of the studies that have been done previously with cardiovascular events back to the basic pathophysiology of the presence of carotid plaque. I think that, again, this study provided an important piece to the puzzle that asthma is associated with increased cardiovascular risk.
C360: And now the application, how do the results of this study contribute to clinical practice?
Dr Tattersall: Well, it's a really good question, and I think this is something that is the basis for all of our research, which is how can this be clinically translated? I think that the bottom line is that identification of people who are at higher cardiovascular risk allows the physician to then address these modifiable risk factors. I think one of the big pieces of our work is the identification that asthma, which is an airway inflammatory disorder, is associated with higher cardiovascular risks. A few years ago, the American Heart Association listed other systemic inflammatory conditions as what they call risk-enhancing conditions. So, when someone's getting their cardiovascular risk assessed, some of these systemic inflammatory conditions can kind of tip the scales, meaning that the presence of these inflammatory conditions confers a higher cardiovascular risk. So, that allows the physician to be more aggressive with the modifiable risk factors. Our work supports the idea that this can be extrapolated and translated to an airway inflammatory condition such as asthma.
C360: What is next for research on persistent asthma, atherosclerotic cardiovascular disease, and carotid plaque burden?
Dr Tattersall: Great question. We have a few ongoing funded studies to understand how to reduce cardiovascular risk in asthma and specifically whether different asthma treatments can reduce the risk of cardiovascular disease.
C360: What are the overall take-home messages from our conversation today and this study?
Dr Tattersall: The overall take-home messages are that in our study we found that persistent asthmatics, those individuals with more severe forms of asthma had a higher carotid plaque burden and more carotid plaque presence compared to those without asthma. These findings compel the physicians who are seeing patients with more significant forms of asthma to counter and balance these things into assessing cardiovascular risk and consideration for more aggressive treatment of modifiable risk factors.
I think the bottom line is that we're quite excited about our research, and we feel that this can have a direct application to the 25 million asthmatic individuals across the United States. Really thank you for your time and for this interview.