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.
We examined the relation of common allergic symptoms and coronary heart disease (CHD) based on a representative survey of the United States population. Because asthma can be complicated by accelerated decrease in pulmonary function, increased airway infection, and use of a β agonist, which are risk factors for cardiovascular disease, we focused on symptoms of allergic rhinoconjunctivitis and wheezing, which stands for nonspecific bronchial hyper-reactivity with adjustment of several co-morbidities including asthma, chronic obstructive pulmonary disease (COPD), and congestive heart failure.
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 obtained.
Self-reported allergic symptoms were categorized into no symptoms (NO), symptoms of allergic rhinoconjunctivitis without wheezing (RC), and wheezing (WZ). The RC group was defined by those who answered “yes” to “During the past 12 months, have you had any episodes of stuffy, itch or runny nose, or watery or itchy eyes?,” excluding those who had wheezing to examine the effect of allergic rhinoconjunctivitis without bronchial hyper-reactivity because allergic rhinoconjunctivitis often coexists with asthma or nonspecific bronchial hyper-reactivity. The WZ group was defined by those who answered yes to “Have you had any wheezing or whistling in your chest at any time in the past 12 months?” to see the effect of nonspecific bronchial hypersensitivity irrespective of asthma. Because these symptoms can be manifestations of underlying cardiopulmonary disease, we controlled for asthma, COPD, and congestive heart failure.
CHD was defined by history of heart attack or a positive response to the angina pectoris section of the Rose questionnaire. Participants were considered to have CHD when they answered “yes” to “Have you ever had any pain or discomfort in your chest,” answered “yes” to “Do you get it when you walk uphill or hurry?” or “Do you get it when you walk at an ordinary pace on level ground?,” answered “stop or slow down” to “What do you do if you get it while you are walking?,” answered “relieved” to “If you stand still, what happens to it?,” and located chest pain/discomfort at midsternum or left chest and arm.
All analysis was done with consideration of sampling methods and weights using R 2.6.1 with the survey package ( http://www.r-project.org ) . Pearson chi-square with Rao-Scott second-order correction was performed for categorical variables. Linear regression and subsequent Wald test was used for continuous variables. Multivariate logistic regression was used to obtain odds ratios (ORs) of CHD according to allergic symptoms with serial adjustments. A p value <0.05 was considered statistically significant.
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 highest in the WZ group followed by the NO and RC groups.
| Variable | NO | RC | WZ | p Value |
|---|---|---|---|---|
| 36.5% | 45.9% | 17.6% | ||
| Age (years), mean ± SE | 45.1 ± 0.6 | 43.2 ± 0.5 | 43.0 ± 0.7 | <0.001 |
| Women | 47.9% | 52.5% | 50.3% | 0.112 |
| White | 70.6% | 80.0% | 81.3% | <0.001 |
| African-American | 13.5% | 9.1% | 7.8% | |
| Mexican-American | 7.2% | 4.3% | 3.5% | |
| Education (years) | <0.001 | |||
| <9 | 13.2% | 8.9% | 11.7% | |
| 9–11 | 15.9% | 10.0% | 16.6% | |
| ≥12 | 70.9% | 81.1% | 71.7% | |
| Current smoker | 27.8% | 20.9% | 48.8% | <0.001 |
| Alcohol (drinks) | 0.001 | |||
| 0 | 14.6% | 12.1% | 8.5% | |
| ≤10/month | 56.8% | 55.1% | 56.6% | |
| >10/month | 28.6% | 32.7% | 34.9% | |
| Inactivity within 1 month | 15.5% | 11.7% | 17.0% | 0.002 |
| Coronary heart disease | 3.9% | 4.8% | 12.8% | <0.001 |
| Asthma | 3.6% | 4.1% | 29.2% | <0.001 |
| Congestive heart failure | 1.4% | 1.2% | 5.1% | <0.001 |
| Chronic obstructive pulmonary disease | 3.1% | 4.9% | 22.0% | <0.001 |
| Hypertension | 26.0% | 27.2% | 33.3% | 0.004 |
| Type 2 diabetes | 6.0% | 5.4% | 7.1% | 0.141 |
| Body mass index (kg/m 2 ) | ||||
| <25 | 43.4% | 47.1% | 41.7% | 0.004 |
| 25–30 | 34.3% | 33.0% | 30.6% | |
| ≥30 | 22.3% | 19.8% | 27.7% | |
| Waist circumference (men >102 cm, women >88 cm) | 37.3% | 32.9% | 43.1% | 0.002 |
| Cholesterol ≥240 mg/dl | 18.5% | 17.4% | 17.6% | 0.698 |
| Low high-density lipoprotein cholesterol (men <40 mg/dl, women <50 mg/dl) | 37.0% | 35.8% | 42.1% | 0.062 |
| C-reactive protein (mg/dl), mean ± SE | 0.393 ± 0.013 | 0.372 ± 0.012 | 0.470 ± 0.024 | 0.008 |
ORs of CHD according to allergic symptoms with sequential adjustments are listed in Table 2 . Without adjustment, RC showed a weak but insignificant association, whereas WZ showed a strong association with CHD compared to NO. Interestingly, the association according to RC and WZ became stronger and significant with adjustment of age, gender, race, education, current smoking, alcohol intake, and physical inactivity (model 2). Even after adjustment with cardiopulmonary diseases such as asthma, congestive heart failure, and COPD (model 3), allergic symptoms remained significantly associated with CHD. After further adjustment for hypertension, type 2 diabetes, abdominal obesity, high-density lipoprotein cholesterol, cholesterol, and C-reactive protein (model 4), RC and WZ were significantly associated with CHD. ORs according to traditional risk factors are also listed in Table 2 for comparison.
| Model | ||||
|---|---|---|---|---|
| 1 | 2 | 3 | 4 | |
| OR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) | |
| Allergic symptoms | ||||
| None | 1 | 1 | 1 | 1 |
| Rhinoconjunctivitis | 1.24 (0.94–1.62) | 1.45 (1.08–1.94) ⁎ | 1.42 (1.03–1.94) ⁎ | 1.40 (1.02–1.92) ⁎ |
| Wheezing | 3.58 (2.68–4.78) ‡ | 4.20 (3.06–5.76) ‡ | 2.85 (1.92–4.24) ‡ | 2.64 (1.79–3.90) ‡ |
| Co-morbidities | ||||
| Asthma | 2.06 (1.35–3.15) † | 2.20 (1.41–3.43) † | 0.96 (0.57–1.62) | 0.95 (0.57–1.59) |
| Congestive heart failure | 39.09 (23.64–64.65) ‡ | 22.04 (12.91–37.61) ‡ | 17.72 (10.32–30.42) ‡ | 15.52 (9.17–26.26) ‡ |
| Chronic obstructive pulmonary disease | 4.72 (3.38–6.60) ‡ | 3.47 (2.44–4.95) ‡ | 2.27 (149–3.47) ‡ | 2.21 (1.42–3.43) † |
| Hypertension | 3.53 (2.72–4.58) ‡ | 2.00 (1.43–2.79) ‡ | — | 1.44 (1.03–2.00) ⁎ |
| Type 2 diabetes | 3.10 (2.32–4.13) ‡ | 1.67 (1.29–2.16) ‡ | — | 1.08 (0.74–1.56) |
| Waist circumference (men >102 cm, women >88 cm) | 2.10 (1.68–2.61) ‡ | 1.42 (1.12–1.81) † | — | 1.04 (0.77–1.41) |
| High-density lipoprotein cholesterol (men <40 mg/dl, women <50 mg/dl) | 1.89 (1.48–2.43) ‡ | 1.86 (1.45–2.38) ‡ | — | 1.62 (1.20–2.18) † |
| Cholesterol ≥240 mg/dl | 1.30 (1.03–1.65) ⁎ | 0.84 (0.65–1.08) | — | 0.82 (0.63–1.07) |
| C-reactive protein (mg/dl) | ||||
| <0.22 | 1 | 1 | — | 1 |
| 0.22–1.00 | 2.01 (1.47–2.76) ‡ | 1.54 (1.11–2.14) ⁎ | — | 1.20 (0.83–1.72) |
| ≥1.00 | 3.73 (2.62–5.32) ‡ | 2.56 (1.73–3.80) ‡ | — | 1.80 (1.14–2.83) ⁎ |
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