{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T23:28:00Z","timestamp":1788996480532,"version":"build-2803163510"},"reference-count":33,"publisher":"European Respiratory Society (ERS)","issue":"5","license":[{"start":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T00:00:00Z","timestamp":1698796800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIHR Imperial Biomedical Research Council"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2023,10,23]]},"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Observational studies suggest asthma is a risk factor for coronary heart disease (CHD) and sex modifies the risk, but they may suffer from methodological limitations. To overcome these, we applied a \u201ctriangulation approach\u201d, where different methodologies, with different potential biases, were leveraged to enhance confidence in findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>First, we conducted an observational study using UK medical records to match asthma patients 1:1, by age, sex and general practitioner (GP) practice, to the general population. We measured the association between asthma and incident CHD (myocardial infarction: hospitalisation\/death) by applying minimal sufficient adjustment: model 1, smoking, body mass index, oral corticosteroids, atopy and deprivation; model 2, additionally adjusting for healthcare behaviour (GP consultation frequency). Second, we conducted a Mendelian randomisation (MR) study using data from the UK Biobank, Trans-National Asthma Genetic Consortium (TAGC) and Coronary Artery Disease Genome-wide Replication and Meta-analysis consortium (CARDIoGRAM). Using 64 asthma single nucleotide polymorphisms, the effect of asthma on CHD was estimated with inverse variance-weighted meta-analysis and methods that adjust for pleiotropy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In our observational study (n=1\u2009522\u2009910), we found asthma was associated with 6% increased risk of CHD (model 1: HR 1.06, 95% CI 1.01\u20131.13); after accounting for healthcare behaviour, we found no association (model 2: HR 0.99, 95% CI 0.94\u20131.05). Asthma severity did not modify the association, but sex did (females: HR 1.11, 95% CI 1.01\u20131.21; males: HR 0.91, 95% CI 0.84\u20130.98). Our MR study (n=589\u2009875) found no association between asthma and CHD (OR 1.01, 95% CI 0.98\u20131.04) and no modification by sex.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings suggest that asthma is not a risk factor for CHD. Previous studies may have suffered from detection bias or residual confounding.<\/jats:p><\/jats:sec>","DOI":"10.1183\/13993003.01788-2023","type":"journal-article","created":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T15:45:46Z","timestamp":1699544746000},"page":"2301788","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":24,"title":["Asthma and incident coronary heart disease: an observational and Mendelian randomisation study"],"prefix":"10.1183","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7596-4846","authenticated-orcid":false,"given":"Carlos A.","family":"Valencia-Hern\u00e1ndez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiola","family":"Del Greco M","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varun","family":"Sundaram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Portas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9166-3958","authenticated-orcid":false,"given":"Cosetta","family":"Minelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1285-7602","authenticated-orcid":false,"given":"Chloe I.","family":"Bloom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2023,11,9]]},"reference":[{"key":"2024102103204020000_62.5.2301788.1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/25.3.617"},{"key":"2024102103204020000_62.5.2301788.2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyh081"},{"key":"2024102103204020000_62.5.2301788.3","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2004.026484"},{"key":"2024102103204020000_62.5.2301788.4","doi-asserted-by":"publisher","DOI":"10.1378\/chest.06-2824"},{"key":"2024102103204020000_62.5.2301788.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2007.12.024"},{"key":"2024102103204020000_62.5.2301788.6","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kws181"},{"key":"2024102103204020000_62.5.2301788.7","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.ejim.2014.10.023","article-title":"Adult asthmatics increase the risk of acute coronary syndrome: a nationwide population-based cohort study","volume":"25","author":"Chung","year":"2014","journal-title":"Eur J Intern Med"},{"key":"2024102103204020000_62.5.2301788.8","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201502-0302OC"},{"key":"2024102103204020000_62.5.2301788.9","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1001\/jamacardio.2018.1901","article-title":"Associations of asthma and asthma control with atrial fibrillation risk results from the Nord-Tr\u00f8ndelag Health Study (HUNT)","volume":"3","author":"Cepelis","year":"2018","journal-title":"JAMA Cardiol"},{"key":"2024102103204020000_62.5.2301788.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-019992"},{"key":"2024102103204020000_62.5.2301788.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.11.063"},{"key":"2024102103204020000_62.5.2301788.12","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1007\/s10654-019-00562-x","article-title":"Asthma, asthma control and risk of acute myocardial infarction: HUNT study","volume":"34","author":"Cepelis","year":"2019","journal-title":"Eur J Epidemiol"},{"key":"2024102103204020000_62.5.2301788.13","doi-asserted-by":"publisher","DOI":"10.1136\/bmjresp-2019-000470"},{"key":"2024102103204020000_62.5.2301788.14","doi-asserted-by":"crossref","first-page":"e007685","DOI":"10.1161\/CIRCEP.119.007685","article-title":"Persistent asthma is associated with increased risk for incident atrial fibrillation in the MESA","volume":"13","author":"Tattersall","year":"2020","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2024102103204020000_62.5.2301788.15","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1038\/s41598-020-79264-4","article-title":"Adults with current asthma but not former asthma have higher all-cause and cardiovascular mortality: a population-based prospective cohort study","volume":"11","author":"He","year":"2021","journal-title":"Sci Rep"},{"key":"2024102103204020000_62.5.2301788.16","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1161\/HYPERTENSIONAHA.119.13183","article-title":"Does poorer pulmonary function accelerate arterial stiffening? 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