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. 2020 Jan;8(1):188-194.e8.
doi: 10.1016/j.jaip.2019.06.043. Epub 2019 Jul 16.

Risk of Acute Myocardial Infarction and Ischemic Stroke in Patients with Asthma Exacerbation: A Population-Based, Self-Controlled Case Series Study

Yoshihiko Raita  1 , Carlos A Camargo Jr  2 , Mohammad Kamal Faridi  2 , David F M Brown  2 , Yuichi J Shimada  3 , Kohei Hasegawa  2
Affiliations

Risk of Acute Myocardial Infarction and Ischemic Stroke in Patients with Asthma Exacerbation: A Population-Based, Self-Controlled Case Series Study

Yoshihiko Raita et al. J Allergy Clin Immunol Pract. 2020 Jan.

Abstract

Background: Patients with asthma have a high incidence of acute myocardial infarction and ischemic stroke.

Objective: To investigate the acute effect of asthma exacerbation on these cardiovascular events.

Methods: Using population-based inpatient data of 3 geographically diverse US states (Florida, Nebraska, and New York) during the period 2011 to 2014, we conducted a self-controlled case series study of adults (aged ≥40 years) hospitalized with asthma exacerbation. The primary outcome was a composite of acute myocardial infarction and ischemic stroke. We used conditional Poisson regression to compare each patient's incidence rate of the outcome during 3 sequential risk periods (1-7, 8-14, and 15-28 days after asthma exacerbation) with that of the reference period (ie, summed period before and after the 3 risk periods).

Results: We identified 4607 adults hospitalized for asthma exacerbation who had a first episode of acute myocardial infarction or ischemic stroke. During the reference period, the incidence rate of acute myocardial infarction or ischemic stroke was 25.0/100 person-years. Compared with the reference period, the incidence rate significantly increased during the first risk period (129.1/100 person-years), with a corresponding adjusted incidence rate ratio of 5.04 (95% CI, 4.29-5.88; P < .001). In the 2 subsequent risk periods, the incidence rate declined but remained high-50.1/100 person-years (adjusted incidence rate ratio, 1.96; 95% CI, 1.51-2.48; P < .001) and 38.0/100 person-years (adjusted incidence rate ratio, 1.48; 95% CI, 1.20-1.81; P < .001), respectively. The findings were similar when the 2 outcomes were examined separately.

Conclusions: In this population-based study of adults with asthma, the risk of acute myocardial infarction and ischemic stroke increased significantly after asthma exacerbation.

Keywords: Asthma exacerbation; Ischemic stroke; Myocardial infarction; Self-controlled case series design.

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