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Original Investigation
August 2018

Associations of Asthma and Asthma Control With Atrial Fibrillation RiskResults From the Nord-Trøndelag Health Study (HUNT)

Author Affiliations
  • 1Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
  • 2Department of Thoracic and Occupational Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
  • 3K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
  • 4Medical Research Council Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
  • 5Department of Cardiology, St Olavs Hospital, Trondheim, Norway
  • 6Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
  • 7Stroke Unit, Department of Internal Medicine, St Olav’s Hospital, Trondheim, Norway
  • 8Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
  • 9Regional Centre for Health Care Improvement, St Olav’s Hospital, Trondheim University Hospital, Norway
JAMA Cardiol. 2018;3(8):721-728. doi:10.1001/jamacardio.2018.1901
Key Points

Question  What is the association between asthma, levels of asthma control, and atrial fibrillation?

Findings  In this cohort study of 54 567 participants, diagnosed asthma was associated with a 38% increased risk of atrial fibrillation, and there was a dose-response association between levels of asthma control and atrial fibrillation.

Meaning  Lack of asthma control was associated with moderately increased risk of atrial fibrillation; given poor asthma control in general population, the observed association has clinical and public health importance.

Abstract

Importance  Asthma, a chronic inflammatory airway disease, and atrial fibrillation (AF) share several common pathophysiological mechanisms. Research on the association between asthma and atrial fibrillation is lacking, and to our knowledge, no previous studies have assessed the dose-response association between levels of asthma control and AF.

Objective  To assess the association between asthma, levels of asthma control, and AF.

Design, Setting, and Participants  This prospective population cohort analyzed data on adults from a second and third iteration of the survey-based Nord-Trøndelag Health Study (HUNT) in Norway. All included participants were free from AF at baseline. Atrial fibrillation was ascertained by linking HUNT data with hospital records from the 2 hospitals in Nord-Trøndelag County. Data analysis was completed from May 2017 to November 2017.

Exposures  Self-reported asthma was categorized into 3 groups: those who had ever had asthma, those who self-report being diagnosed with asthma, and those who had active asthma. Asthma control was defined according to Global Initiative for Asthma guidelines and was categorized into controlled, partly controlled, and uncontrolled cases.

Main Outcomes and Measures  Atrial fibrillation.

Results  A total of 54 567 adults were included (of whom 28 821 [52.8%] were women). Of these, 5961 participants (10.9%) reported ever having asthma, 3934 participants (7.2%) reported being diagnosed with asthma, and 2485 participants (4.6%) reported having active asthma. During a mean (SD) follow-up of 15.4 (5.8) years, 2071 participants (3.8%) developed AF. Participants with physician-diagnosed asthma had an estimated 38% higher risk of developing AF (adjusted hazard ratio, 1.38 [95% CI, 1.18-1.61]) compared with participants without asthma. There was a dose-response association between levels of asthma control and risk of AF with the highest risk for AF in participants with uncontrolled asthma (adjusted hazard ratio, 1.74 [95% CI, 1.26–2.42]; P for trend < .001).

Conclusions and Relevance  Asthma and lack of asthma control were associated with moderately increased risks of AF in a dose-response manner. Further studies are needed to explore the underlying mechanisms and clarify causal pathways between asthma and AF.

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