15 Feb Asthma May Raise Risk of Abdominal Aortic Aneurysm Rupture
MedicalResearch.com Interview with:
Guo-Ping Shi, ScD and Dr. Cong-Lin Liu
Cardiovascular Medicine
Brigham and Women’s Hospital
Boston, MA
Guo-Ping Shi, ScD and Dr. Cong-Lin Liu
Cardiovascular Medicine
Brigham and Women’s Hospital
Boston, MA
Medical Research: What is the background for this study? What are the main findings?
Response: Abdominal aortic aneurysm (commonly called AAA) is an aortic disease that affects 1~5% men above 50, depending on the countries and regions. There is currently no effective medication or prevention besides surgical repair. Fast growth or unstable AAA often leads to aortic rupture and sudden death. Although ultrasound can be used to monitor the size and growth of AAA, our current annual health examination system in the US does not include this service.
We report that mast cells are essential to AAA (J Clin Invest. 2007;117:3359-68). These cells are predominant immune cells in allergic asthmatic lungs from humans and experimental animals. Plasma immunoglobulin E (IgE) level elevation is also a signature of allergic asthma. We report that IgE contributes to experimental AAA by activating mast cells, as well as other immune cells such as macrophages and T cells (EMBO Mol Med. 2014;6:952-69). Direct evidence from our recent study demonstrates that production of allergic asthma in mice doubles the AAA sizes in experimental mice (Arterioscler Thromb Vasc Biol. 2016;36:69-77). All these prior studies suggest a role of allergic asthma to the pathogenesis of AAA.
In this human population-based nationwide case-control study (Arterioscler Thromb Vasc Biol. 2016 Feb 11. [Epub ahead of print]), we reported two major findings: First, among 15,942 Danish AAA patients selected from 1996 to 2012, compared to those who did not have asthma, patients who had hospital-diagnosed asthma within the past 12 months had 60% more risk to experience aortic rupture, and those who had hospital-diagnosed asthma within the past 6 months had greater than 100% more risk to experience aortic rupture. Further, patients who received anti-asthmatic treatment, as evidence of asthma, also had 20~50% more risk of experiencing aortic rupture than those who did not have record of anti-asthmatic treatment, depending on how recent the patients received the treatments.
Second, among a general men population aged from 65 to 74, patients who used bronchodilating drugs to treat asthma or reversible obstructive pulmonary disease had 45% more risk to have AAA compared with those who never used bronchodilators. This risk was not affected by smoking or other major AAA risk factors.
Medical Research: What should clinicians and patients take away from your report?
Response: Patients with AAA should be aware that your recent asthma might increase your risk of aortic rupture and sudden death. It may be helpful to have more frequent monitoring. Further, men over 50 and with chronic asthma or other allergic diseases may have higher risk to develop AAA than those without these allergic diseases.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: This current human study agrees with prior discoveries from experimental models that mast cells and IgE are both important players in asthma and AAA. Mast cell inhibitors cromolyn and Zaditor® and anti-IgE antibody Xolair® may have therapeutic efficacy not only to asthmatic patients, but also those with AAA. This hypothesis should be tested.
Medical Research: Is there anything else you would like to add?
Response: This study tested only the population with hospital-diagnosed asthma and those received bronchodilating drugs. Although not tested, patients with other chronic allergic diseases may also have increased risk of developing AAA or experiencing aortic rupture.
Citation:
Asthma Associates With Human Abdominal Aortic Aneurysm and Rupture
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Guo-Ping Shi, DSc and Dr. Cong-Lin Liu (2016). Asthma May Raise Risk of Abdominal Aortic Aneurysm Rupture
Last Updated on July 22, 2020 by Marie Benz MD FAAD