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This Article Full Text (PDF) All Versions of this Article: chest.07-3126v1 134/3/546    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Google Scholar Articles by Camargo, C. A. Articles by Speizer, F. E. PubMed PubMed Citation Articles by Camargo, C. A., Jr. Articles by Speizer, F. E.

Prospective Study of Inhaled Corticosteroid Use, Cardiovascular Mortality, and All-Cause Mortality in Asthmatic Women

From the Channing Laboratory, Department of Medicine, Brigham & Women's Hospital (Drs. Camargo and Barr, Ms. Chen, and Dr. Speizer) and Department of Emergency Medicine, Massachusetts General Hospital (Dr. Camargo), Harvard Medical School, Boston, MA; and Division of General Medicine, Department of Medicine, and Department of Epidemiology, Columbia University Medical Center, New York, NY (Dr. Barr)

ccamargo{at}partners.org

Abstract

BackgroundInhaled corticosteroids (ICS) decrease risk of asthma exacerbations. Recent studies suggest that ICS also may decrease risk of cardiovascular disease and perhaps all-cause mortality. We examined this hypothesis in a large, well-characterized cohort of asthmatic women.

MethodsIn 1976, the Nurses' Health Study enrolled 121,700 registered nurses, ages 30-55 years. Participants were asked about "physician-diagnosed asthma" on biennial questionnaires. In 1998, asthmatic participants were sent a supplementary questionnaire on asthma diagnosis and management, including ICS use. Mortality was assessed through 2003, without knowledge of the 1998 (baseline) ICS status. Odds ratios (OR) for death were adjusted for age, asthma severity, smoking, heart disease, cancer, stroke, aspirin, and statin use.

ResultsAmong 2,671 eligible women (i.e., those who responded to the 1998 supplement [85%], met criteria for persistent asthma, and had no prior diagnosis of COPD), 54% reported ICS use. Over the next 5 years, 87 (3.3%) women died; 22 were cardiovascular deaths, 31 cancer, and 34 other (including 4 asthma). Compared to asthmatic women not on ICS, those on ICS had lower all-cause mortality (OR 0.58; 95%CI, 0.36-0.92). ICS users were at significantly lower risk of cardiovascular death (OR 0.35; 95%CI, 0.13-0.93) but not death from cancer (OR 0.66; 95%CI, 0.32-1.38) or other causes (OR 0.62; 95%CI, 0.30-1.27).

ConclusionsICS use was associated with significantly lower cardiovascular and all-cause mortality in women with asthma. These observational data suggest that ICS may indeed have anti-inflammatory benefits beyond the airway, a possibility that merits further study.

Key Words: All-cause mortality • Asthma • Cardiovascular mortality • Inhaled corticosteroids