title: Cardiovascular disease risk associated with asthma and respiratory morbidity might be mediated by short-acting beta2-agonists.
abstract: 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 beta(2)-agonist use, itself associated with CVD events.
  
  
  OBJECTIVE
  We assessed the relationship between incident CVD/stroke and asthma and the effect of atopy while controlling for beta(2)-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 FEV(1) reversibility. Current short- and long-acting beta(2)-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 beta(2)-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 FEV(1) of less than 80% of predicted value but an FEV(1)/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 beta(2)-agonist-related risk in persons without existing CVD. CVD risk in relation to atopic status of asthma also requires further investigation.
authors.affiliation: The Health Observatory, Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, Australia. sarah.appleton@adelaide.edu.au
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Appleton
authors.forename: Richard E
authors.initials: RE
authors.lastname: Ruffin
authors.forename: David H
authors.initials: DH
authors.lastname: Wilson
authors.forename: Anne W
authors.initials: AW
authors.lastname: Taylor
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Adams
mesh_terms: D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D001249:Asthma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D001315:Australia; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012737:Sex Factors; D020521:Stroke / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011795:Surveys and Questionnaires
chemical_list: D000318:Adrenergic beta-Agonists