Cardiovascular Journal of Africa: Vol 26 No 1 (January/February 2015)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 26, No 1, January/February 2015

AFRICA

Abdominal aortic stiffness as a marker of atherosclerosis

in childhood-onset asthma: a case–control study

Zülal Ülger, Figen Gülen, Arif Ruhi Özyürek

Abstract

Background:

Asthma is one of the chronic inflammatory

diseases. It is known that chronic inflammation accelerates

atherosclerosis. Abdominal aortic stiffness parameters can be

used to detect the early development of atherosclerosis.

Aim:

In this study, we aimed to evaluate abdominal aortic

stiffness parameters in childhood-onset asthma compared

with a control group.

Methods:

In this cross-sectional, case–control study, we

evaluated 50 patients with childhood-onset asthma, and 57

healthy children as controls. Patients with a diagnosis of

asthma of at least three years’ duration were included in the

study. Children with hypertension, hyperlipidaemia, diabe-

tes, a history of smoking contact, or systemic disease were

excluded. The study and control groups were evaluated with

transthoracic echocardiography, and abdominal aorta diam-

eters were measured. Using the measured data, abdominal

aortic stiffness parameters (aortic distensibility: DIS, aortic

strain: S, pressure strain elastic modulus: Ep, and pressure

strain normalised by diastolic pressure: Ep*) were calculated.

Statistical evaluation was done with the Student’s t-test, chi-

squared test and Pearson’s correlation test.

Results:

The study group consisted of 50 children (24 female,

26 male) with asthma. According to the GINA guidelines, 26

of the patients had mild intermittant asthma, six had mild

persistent asthma and 18 had intermediate persistent asthma.

None of the patients had severe asthma. In 37 of the asthma

patients, spIgE was positive and these patients were accepted

as having atopic asthma; 27 of these patients received immu-

notherapy. We did not detect any differences between the

study and control groups in terms of gender, age and body

mass index. No differences were evident between the groups

with regard to systolic and diastolic blood pressure, heart

rate, blood cholesterol levels and respiratory function test

parameters. There was no difference between the asthma and

control groups in the measurement of abdominal aortic stiff-

ness parameters. There was no significant correlation between

aortic stiffness parameters and high-sensitivity C-reactive

protein, blood total cholesterol, LDL cholesterol and HDL

cholesterol levels.

Conclusion:

We did not find any difference between the asth-

ma patients and control group with regard to aortic stiffness

parameters (DIS, S, Ep and Ep*) and there was no differ-

ence in these parameters when we compared patients with

mild asthma with those with moderate asthma. These results

may be due to the anti-inflamatory effect of inhaled steroids.

Further studies are needed to validate these results.

Keywords:

asthma, children, aortic stiffness

Submitted 1/6/14. accepted 14/8/14

Published online 29/9/14

Cardiovasc J Afr

2015;

: 8–12

www.cvja.co.za

DOI: 10.5830/CVJA-2014-046

Asthma is an important health problem in children.

Substantial evidence has demonstrated that asthma is a chronic

inflammatory disease with activation of the inflammatory cells

within the airways. Recent studies have reported that systemic

inflammation is related to disease progression in asthma.

The

pro-inflammatory cytokines such as tumour necrosis factor

alpha (TNF

), interleukin 6 (IL-6) and C-reactive protein (CRP)

are elevated in patients with asthma.

1-3

Atherosclerosis and asthma are both chronic inflammatory

conditions. Inflammation leads to impairment of endothelial cell

function, and chronic inflammation accelarates atherosclerosis.

Elevated arterial stiffness, a marker of subclinical atherosclerosis,

is associated with myocardial infarction, heart failure, stroke,

renal disease and elevated total mortality rates.

Much research has revealed that patients with asthma

are at increased risk of pulmonary embolism, hypertension,

coronary heart disease and heart failure.

6-9

Reduction in arterial

distensibility leads to increased pulse pressure, and impedance of

arterial flow and pulsatile cardiac work load. Arterial stiffness

is a mechanical property related to vascular impedance and the

afterload that is presented to the left ventricle. Abdominal aortic

stiffness increases with age, and in many studies, its usefulness

has been demonstrated.

10-15

In the literaure, changes in abdominal aortic stiffness in

childhood-onset asthma have not been clearly determined. The

purpose of our study was to evaluate abdominal aortic stiffness

in patients with childhood-onset asthma.

Methods

Our study was a cross-sectional, case–control study. Fifty

asthma patients (24 girls, 26 boys) aged eight to 17 years, who

were followed by the paediatric allergy department of our

hospital for at least three years, were included in this study.

Children with hypertension, hyperlipidaemia, diabetes, a history

of smoking contact and systemic disease were excluded. The

asthma diagnosis was established from a history of intermittent

wheezing, the presence of reversible airway obstruction and

at least 12% improvement in forced expiratory volume in one

second (FEV1) following bronchodilator administration.

The Global Initiative for Asthma guidelines (GINA) was used

to determine clinical severity of the asthma.

Twenty-six patients

had mild intermittant asthma, six had mild persistent and 18 had

moderate persistent asthma. Allergen sensitivity in the asthma

Ege University Children’s Hospital,

zmir, Bornova, Turkey

Zülal Ülger, MD,

drzulger@hotmail.com

Figen Gülen, MD

Ruhi Arif Özyürek, MD