Is there a gender-specific association between asthma and carotid intima media thickness in Swiss adolescents?
Respiratory diseases are associated with increased cardiovascular risk in adults, but little is known on the early impact on the vasculature in youth. The SAPALDIA Youth study, the offspring study of the Swiss Study on Air Pollution and Lung and Heart Disease In Adults (SAPALDIA), investigated the association between physician-diagnosed asthma status and common carotid artery intima media thickness (CIMT). Offspring underwent standardized clinical protocols and provided information on early life factors, health, and lifestyle. The association between per subject averages of CIMT and asthma was estimated using mixed linear regression analyses adjusting for main confounders, testing for interaction with gender and age. Of 257 offspring (mean age 15 years, 53% female), 11.5% reported doctor-diagnosed asthma (male 17%, female 7%). Mean CIMT was significantly different by gender (male 0.53 mm (± 0.045), female 0.50 mm (± 0.048); p < 0.001). Interaction was highly significant by gender (p = 0.001) with significantly increased CIMT in asthmatic vs. non-asthmatics boys (difference 0.023 mm, 95% CI 0.003; 0.043), as compared to girls.
What is Known:
• Evidence points to a significant impact of adult respiratory disease on cardiovascular health indicators as well as on endpoints.
• Inflammation is a key pathway in vascular change across the life course.
What is New:
• We observe an adverse association between physician-diagnosed asthma and carotid intima media thickness in adolescent boys.
• Albeit a limited number of asthmatic girls, we hypothesize the gender typical timing of asthma or a higher male cardiovascular vulnerability as possible explanations for the gender-specific results.
KeywordsAsthma Atherosclerosis Epidemiology Carotid intima media thickness
Body mass index
Carotid artery intima media thickness
Forced expiratory volume
Swiss Study on Air Pollution and Lung and Heart Disease In Adults
We thank Prof. Christian Schindler for his statistical support and critical input and the SAPALDIA Youth study participants for providing data and trust in our research.
Julia Dratva is the primary investigator of the SAPALDIA Youth study. She developed the study protocol and supervised the data collection, has developed the hypotheses and analytic plan presented in this paper, conducted the analyses, interpreted the data in conjunction with all authors, and was responsible for writing the first and all consecutive drafts and the submitted paper.
Seraina Caviezel was involved in the CIMT data collection and management, provided analytic support and contributed in the interpretation of the presented results in conjunction with all authors, and participated in the drafting of the manuscript.
Emmanuel Schaffner is involved in the CIMT data management, provided analytic support and contributed in the interpretation of the presented results in conjunction with all authors, and participated in the drafting of the manuscript.
Daiana Stolz was involved in the SAPALDIA Youth data collection as study center physician and pneumologist. She contributed in the interpretation of the presented results in conjunction with all authors, and participated in the drafting of the manuscript.
Thomas Rothe was involved in the SAPALDIA Youth data collection as study center physician and pneumologist. He contributed in the interpretation of the presented results in conjunction with all authors and participated in the drafting of the manuscript.
Nino Kuenzli is a longstanding member of the SAPALDIA cohort study, in which the SAPALDIA Youth study is nested. He oversaw the SAPALDIA 3 survey and the development of the SAPALDIA CIMT protocol and provided methodological support in the development of the SAPALDIA Youth study. He contributed in the interpretation of the presented results in conjunction with all authors and participated in the drafting of the manuscript.
Arno Schmidt-Trucksäss was involved in the SAPALDIA CIMT protocol development, data collection and analyses, contributed to the interpretation of results in conjunction with all authors, and participated in drafting the paper.
Elisabeth Zemp provided methodological support in the development of the SAPALDIA Youth study and contributed in the interpretation of the presented results in conjunction with all authors and participated in the drafting of the manuscript.
Nicole Probst-Hensch is the primary investigator of the SAPALDIA cohort study, in which the SAPALDIA Youth study is nested. She implemented into the SAPALDIA cohort the comorbidity framework between inflammation-related diseases. She provided methodological support in the development and data collection of the SAPALDIA Youth study and contributed in the interpretation of the presented results in conjunction with all authors, and participated in the drafting of the manuscript.
Compliance with ethical standards
Parents signed written informed consent for adolescent < 18 years; as of 15 years of age, adolescent were asked to provide written informed consent. The study protocol was approved by the respective cantonal Ethical Review Boards.
Conflict of interest
The authors declare that they have no conflict of interest.
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