The Relationship Between Allergic Rhinitis, Asthma and Cardiovascular Disease in the National Health Interview Surveys (NHIS), 1999-2018

Background Atopic disease has been associated with immune dysregulation and chronic inflammation, but current practice guideline recommendations do not include the evaluation of inflammatory outcomes among patients with asthma and allergic rhinitis. Objective This study investigates the relationship between asthma, allergic rhinitis and cardiovascular disease (CVD) using data from the US National Health Interview Survey (NHIS) between 1999-2018. Methods We used data from adults in the NHIS (n = 603,140, representing a population of 225,483,286). Exposures were physician-diagnosed asthma (lifetime/past-year) and allergic rhinitis (past-year). Outcomes were physician-diagnosed heart disease: coronary heart disease (CHD), angina, heart-attack, and non-specific “heart-condition” (all lifetime). We used survey-weighted descriptive analysis and logistic regression adjusting for demographic and socioeconomic factors. Results 11.44% reported at least one heart condition, with CHD the most prevalent (4.27%) across 20 years of pooled data. Asthma and rhinitis were associated with higher CVD in all bivariate analyses. Specifically, lifetime asthma was associated with increased odds of CHD, OR=1.36 (1.29, 1.42), with stronger effects observed for a past-year asthma-attack, OR= 1.66 (1.55, 1.80). The strongest effect of all was observed in those with a past-year asthma attack having increased odds of angina, OR=2.42 (2.24, 2.63). Allergic rhinitis was independently associated with increased odds of CHD (OR=1.25, 1.18-1.28). Conclusions Asthma and allergic rhinitis are risk factors for all types of CVD in this nationally representative study covering a two-decade period in the US. Clinicians should consider screening patients with severe and/or uncontrolled asthma and allergic rhinitis early for CVD, particularly angina and CHD. Future studies are warranted to explore the immunological milieu in these patients and identify therapeutic targets.