Relation Between Common Allergic Symptoms and Coronary Heart Disease Among NHANES III Participants

doi:10.1016/j.amjcard.2010.05.029

The American Journal of Cardiology

Volume 106, Issue 7, 1 October 2010, Pages 984-987

https://doi.org/10.1016/j.amjcard.2010.05.029 Get rights and content

We investigated whether there is an increased risk of coronary heart diseases (CHD) in those with common allergic symptoms using the NHANES III, which is a representative sample of the United States population in 1988 to 1994. CHD was defined by Rose questionnaire and history of heart attack. Allergic symptoms were categorized into no symptoms (NO), rhinoconjunctivitis without wheezing (RC), and wheezing (WZ) based on symptoms. Multivariate logistic regression was used to obtain odds ratios (ORs) of CHD. Eight thousand six hundred fifty-three nonpregnant subjects ≥20 years old with overnight fasting ≥8 hours were included. CHD was present in 5.9% of the population; 36.5% did not have allergic symptoms (NO), 45.9% had RC, and 17.6% had WZ. The prevalence of CHD was 3.9% in NO, 4.8% in RC, and 12.8% in WZ (p <0.001). Compared to NO, unadjusted ORs of CHD were 1.24 (95% confidence interval 0.94 to 1.62) in RC and 3.58 (2.68 to 4.78) in WZ and ORs adjusted for sociodemographic factors and co-morbidities were 1.40 (1.02 to 1.92) in RC and 2.64 (1.79 to 3.90) in WZ. Only the group of women <50 years of age had significantly increased ORs in RC and WZ. In conclusion, common allergic symptoms were significantly associated with an increased risk of CHD.

Section snippets

Methods

The National Health and Nutrition Examination Survey (NHANES) III was a sampled survey of the noninstitutionalized civilian population in the United States from 1988 through 1994. In this survey 39,695 subjects were sampled and 30,818 participated in the interview and examination at a mobile examination center. We included subjects ≥20 years of age (16,573) who fasted overnight ≥8 hours (10,308). After excluding those who had missing values or who were pregnant, a final sample of 8,653 was

Results

CHD was present in 5.9% of the population. Characteristics of the population by allergic symptoms are listed in Table 1. Across the spectrum of allergic symptoms from NO to WZ, subjects became younger and more frequently white. Alcohol intake, asthma, COPD, and hypertension were also more prevalent as subjects had more severe allergic symptoms from NO to WZ. Prevalence of smoking, physical inactivity, congestive heart failure, obesity, abdominal obesity, and levels of C-reactive protein were

Discussion

In the present study, we showed that common allergic symptoms of allergic rhinoconjunctivitis or wheezing were associated with CHD. This association was mainly driven by women <50 years of age. In addition, symptoms of allergic rhinoconjunctivitis increased the risk of CHD in women <50 years of age.

Several studies have reported increased risks of cardiovascular disease in asthma.9, 10, 11 However, the apparent association of asthma and CHD might have been confounded. Asthma is a long-term

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Cited by (19)

Increased Risk of Atrial Fibrillation in Patients with Atopic Triad: A Nationwide Population-Based Study
2021, Journal of Allergy and Clinical Immunology: In Practice
Citation Excerpt :
Above all, multiple allergic conditions are difficult to control and more clinically intractable than single conditions. Moreover, because allergic diseases constitute a considerable burden on global health care, there is a growing interest in the relation between allergic and cardiovascular diseases.19,20 Because systemic inflammation and subsequent immune responses have reportedly been linked to the initiation and maintenance of AF, allergic diseases have attracted scientific interest as putative risk factors for AF.
Despite a sharp increase in the global prevalence of allergy over the past decade, the relation between multiple atopic conditions and atrial fibrillation (AF) has not been fully elucidated.
To determine whether there is an association between atopic diseases and AF and to examine the effect of multiple atopic diseases on the incidence of AF.
This retrospective population-based study used the database from the 2009 National Health Insurance Services-Health Screening Cohort in Korea. A total of 6,748,564‬ subjects without a previous history of AF were included in the final analysis and observed until 2017. The atopic triad included asthma, allergic rhinitis, and atopic dermatitis. A total of 1,168,196‬ subjects (17.3%) with at least one atopic disease were classified as the atopic group. The primary outcome was new-onset AF.
During a median 7.2 ± 1.0 years of follow-up, 136,253‬ subjects were given the new diagnosis of AF (30,300 in the atopic group and 105,953 in the nonatopic group). The incidence of AF was 3.63/1000 person-years in the atopic group and 2.64/1000 person-years in the nonatopic group. The risk for AF showed a positive correlation with the number of diseases in the atopic triad (adjusted hazard ratio [aHR], 95% confidence interval [CI]: one disease: aHR = 1.15, CI, 1.14-1.17; two diseases: aHR = 1.34, CI, 1.31-1.38; and three diseases: aHR = 1.35, CI, 1.11-1.66; P for trend < .001).
The atopic triad of asthma, allergic rhinitis, and atopic dermatitis was associated with an increased risk for AF. Moreover, multiple atopic conditions have a higher risk for AF.
Association of allergic rhinitis, coronary heart disease, cerebrovascular disease, and all-cause mortality
2016, Annals of Allergy, Asthma and Immunology
Citation Excerpt :
Asthma has been associated with increased ASCVD and all-cause mortality; however, covariate allergy (broadly defined to include diagnoses of atopic dermatitis, anaphylaxis, and food allergy, in addition to allergic rhinitis [AR]) did not affect outcomes.21,22 Allergic rhinitis has previously been associated with incident hypertension,23 although those results were not duplicated in a similar study,24 and self-reported allergic rhinoconjunctivitis symptoms were associated with increased coronary heart disease (CHD) in one National Health and Nutrition Examination Survey (NHANES) study.25 However, a more recent study of NHANES 2005–2006 data found that having a positive allergen specific IgE (sIgE) test result was inversely related to having a history of an MI.26
Inflammation is implicated in atherosclerotic cardiovascular disease. Allergic diseases also involve a systemic inflammatory state, which may potentiate cardiovascular disease.
To examine the association of allergic rhinitis, coronary heart disease (CHD), cerebrovascular disease (CVD), and all-cause mortality.
We conducted a retrospective, population-based, matched cohort study comparing the incidence of CHD, CVD, and all-cause mortality from January 1, 1999, through December 31, 2012, in patients with International Classification of Disease, Ninth Revision, documented allergic rhinitis matched 1:1 by age, sex, and ethnicity to a reference cohort without allergic rhinitis within Kaiser Permanente Southern California. Fully adjusted hazard ratios (HRs) were calculated. Further analyses for those with positive environmental allergen specific IgE (sIgE) test results within the allergic rhinitis cohort were also performed.
Patients with physician-diagnosed allergic rhinitis (N = 110, 207 in matched cohort) had significantly lower risk for myocardial infarction (HR, 0.63; 95% confidence interval [CI], 0.59–0.67; P < .001), all CHD (HR, 0.81; 95% CI, 0.78–0.84; P < .001), CVD (HR, 0.67; 95% CI, 0.64–0.70; P < .001), and all-cause mortality (HR, 0.42; 95% CI, 0.40–0.43; P < .001). The results were similar after excluding patients with asthma. Patients with positive sIgE test result also had a decreased risk of all CHD (relative risk [RR], 0.87; 95% CI, 0.79–0.95; P = .003) but no association with cerebrovascular events (RR, 0.89; 95% CI, 0.77–1.02; P = .10) and all-cause mortality (RR, 1.16; 95% CI, 1.00–1.34; P = .06).
We found that the presence of allergic rhinitis was associated with decreased CHD, CVD, and all-cause mortality. This decreased risk was more pronounced after excluding patients with asthma. Patients with positive sIgE test results also had decreased risk of CHD.
Trans-disciplinary research in synthesis of grass pollen aerobiology and its importance for respiratory health in Australasia
2015, Science of the Total Environment
Citation Excerpt :
Kim et al. (2010) examined The National Health and Nutrition Examination Survey (NHANES) III data for an association between allergic disease and cardiovascular risk in over 30,000 participants in the United States of America (Kim et al., 2010). Common symptoms of allergic rhinoconjunctivitis or wheezing were associated with cardiovascular disease, predominantly in women less than 50 years of age (Kim et al., 2010). Furthermore, research by (Straka et al., 2013), found that incidences of angiotensin-converting enzyme inhibitor-associated angioedema increased during the tree and ragweed pollen season.
Grass pollen is a major trigger for allergic rhinitis and asthma, yet little is known about the timing and levels of human exposure to airborne grass pollen across Australasian urban environments. The relationships between environmental aeroallergen exposure and allergic respiratory disease bridge the fields of ecology, aerobiology, geospatial science and public health.
The Australian Aerobiology Working Group comprised of experts in botany, palynology, biogeography, climate change science, plant genetics, biostatistics, ecology, pollen allergy, public and environmental health, and medicine, was established to systematically source, collate and analyse atmospheric pollen concentration data from 11 Australian and six New Zealand sites. Following two week-long workshops, post-workshop evaluations were conducted to reflect upon the utility of this analysis and synthesis approach to address complex multidisciplinary questions.
This Working Group described i) a biogeographically dependent variation in airborne pollen diversity, ii) a latitudinal gradient in the timing, duration and number of peaks of the grass pollen season, and iii) the emergence of new methodologies based on trans-disciplinary synthesis of aerobiology and remote sensing data. Challenges included resolving methodological variations between pollen monitoring sites and temporal variations in pollen datasets. Other challenges included “marrying” ecosystem and health sciences and reconciling divergent expert opinion. The Australian Aerobiology Working Group facilitated knowledge transfer between diverse scientific disciplines, mentored students and early career scientists, and provided an uninterrupted collaborative opportunity to focus on a unifying problem globally. The Working Group provided a platform to optimise the value of large existing ecological datasets that have importance for human respiratory health and ecosystems research. Compilation of current knowledge of Australasian pollen aerobiology is a critical first step towards the management of exposure to pollen in patients with allergic disease and provides a basis from which the future impacts of climate change on pollen distribution can be assessed and monitored.
Rhinitis in a community elderly population: Relationships with age, atopy, and asthma
2013, Annals of Allergy, Asthma and Immunology
Rhinitis is one of the most frequent medical conditions. However, there is sparse epidemiologic evidence for rhinitis in the elderly population.
To investigate the prevalence of rhinitis in elderly adults and its relations to asthma and other comorbidities.
A cross-sectional analysis was performed using the baseline dataset of the Korean Longitudinal Study on Health and Aging, a community-based elderly population cohort in Korea (≥65 years old). Structured questionnaires were used to define rhinitis, asthma, and comorbidity, and allergen skin prick tests were used to define atopy. Health-related quality of life was assessed by short-form 36 questionnaires.
In total, 982 elderly adults (98.2%) were included in the present study. The prevalence of rhinitis was 25.6% and did not decrease until 90 years of age. The prevalence of atopy was 17.2% (18.8% in participants with rhinitis), and atopy did not show a significant association with rhinitis. In multivariate logistic regression analyses, relations between asthma and rhinitis were significant. Among comorbid conditions, none were significantly associated with rhinitis. In the short-form 36 questionnaire analyses, rhinitis was independently related to a decrease in the physical aspects of quality of life.
The present study found a high prevalence of nonallergic rhinitis in elderly participants, which was significantly related to asthma and quality of life.
Coronary hypersensitivity disorder: The kounis syndrome
2013, Clinical Therapeutics
Citation Excerpt :
The following additional findings support the existence of Kounis syndrome. Common allergic symptoms such as allergic rhinoconjunctivitis and wheezing were reported to have been significantly associated with an increased risk for ischemic heart disease (IHD) in the National Health and Nutrition Survey III on noninstitutionalized civilian population in the United States, 1988–1994.65 In another report, eosinophil counts were significantly increased in patients with vasospastic angina pectoris and might predict the severity of the disease.
When allergy or hypersensitivity and anaphylactic or anaphylactoid insults lead to cardiovascular symptoms and signs, including acute coronary events, the result might be the recently defined nosologic entity Kounis syndrome. Vasospastic allergic angina, allergic myocardial infarction, and stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells are the 3 reported variants of this syndrome.
The purpose of this review was to highlight and consolidate the recent literature on allergic angina and allergic myocardial infarction and to propose new therapeutic modalities for stabilizing mast cells.
A search for current literature on the pathophysiology, causality, clinical appearance, variance, prevention, and treatment of Kounis syndrome was conducted.
Kounis syndrome is caused by inflammatory mediators such as histamine; neutral proteases, including tryptase, chymase, and cathepsin-D; arachidonic acid products; platelet-activating factor; and a variety of cytokines and chemokines released during the mast-cell activation. Platelets with Fc γ receptor (FcγR) Ι, FcγRII, FcεRI, and FcεRII also have a role in the activation cascade. The same mediators released from the similar inflammatory cells are involved in acute coronary events of nonallergic etiology. These cells are not only present in the involved region before plaque erosion or rupture but also release their contents just before an acute coronary event. Pro-inflammatory mediators similar to those found in Kounis syndrome are found in some cases with nonallergic etiology, suggesting that this is a more general problem. The acute coronary and cerebrovascular events in Kounis syndrome may be prevented by the inhibition of mast-cell degranulation. Substances and natural molecules that protect the mast-cell surface and stabilize the mast-cell membrane are emerging as novel agents in the prevention of acute coronary and other arterial events.
The 3 reported variants of Kounis syndrome—vasospastic allergic angina, allergic myocardial infarction, and stent thrombosis with occluding thrombus—are caused by inflammatory mediators. Agents that inhibit mast-cell degranulation may be efficacious in preventing the acute coronary and cerebrovascular events of Kounis syndrome.
Relation between objective measures of atopy and myocardial infarction in the United States
2013, Journal of Allergy and Clinical Immunology
Although rodent studies indicate that atherosclerosis is a T_H1-mediated disease and that atopic T_H2 immunity is atheroprotective, findings in humans are conflicting. Total IgE (tIgE) is associated with atherosclerotic disease but has limited specificity for atopy.
Our aim was to determine the relation between atopy, as indicated by a broad panel of serum allergen-specific IgE (sIgE), and past myocardial infarction (MI) in a sample representative of the US population.
Data were analyzed from 4002 participants aged ≥20 years from the 2005-2006 National Health and Nutrition Examination Survey.
Subjects reporting a history of MI had lower summed sIgE (5.51 vs 7.71 kU/L; P < .001) and were less likely to have ≥1 positive sIgE test (29.9% vs 44.6%; P = .02) or current hay fever (3.3% vs 7.6%; P = .002). After adjustment for age, sex, race/ethnicity, diabetes mellitus, hypertension, family history of MI, smoking, total/high-density lipoprotein cholesterol, body mass index, and C-reactive protein, the odds ratio (OR) for MI was 0.91 (95% CI, 0.85-0.97) per positive sIgE; 0.70 (95% CI, 0.57-0.85) per 2-fold increase in sum[sIgE]; and 0.82 (95% CI, 0.69-0.98) per 10% increase in the ratio of sum[sIgE] to tIgE. Analysis with 7 data-driven, prespecified allergen clusters found that house dust mite is the only allergen cluster for which sIgE is associated with reduced odds for MI (fully adjusted OR, 0.36; 95% CI, 0.20-0.64).
Serum sIgE is inversely related to MI in the US population in a manner independent of multiple coronary risk factors.

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Preventive cardiologyRelation Between Common Allergic Symptoms and Coronary Heart Disease Among NHANES III Participants

Section snippets

Methods

Results

Discussion

J Allergy Clin Immunol

Chest

J Allergy Clin Immunol

Am J Pathol

Trends Cardiovasc Med

Trends Immunol

A 15-year follow-up study of Ventilatory Function in Adults with asthma

N Engl J Med

Lung function and incident coronary heart disease: the Atherosclerosis Risk in Communities Study

Am J Epidemiol

Elevated infection parameters and infection symptoms predict an acute coronary event

Ther Adv Cardiovasc Dis

The burden of allergic rhinitis

Allergy Asthma Proc

Cardiovascular Survey Methods

Do patients with severe asthma run an increased risk from ischaemic heart disease?

Int J Epidemiol

Are patients with asthma at increased risk of coronary heart disease?

Int J Epidemiol

Preventive cardiology
Relation Between Common Allergic Symptoms and Coronary Heart Disease Among NHANES III Participants