Abstract
Cysteinyl leukotrienes are proinflammatory mediators with a clinically established role in asthma and a human genetic and preclinical role in cardiovascular pathology. Given that cardiovascular disease has a critical inflammatory component, the aim of this work was to conduct an observational study to verify whether the use of a cysteinyl leukotriene antagonist, namely, montelukast, may protect asthmatic patients from a major cardiovascular event and, therefore, represent an innovative adjunct therapy to target an inflammatory component in cardiovascular disease. We performed an observational retrospective 3-year study on eight hundred adult asthmatic patients 18 years or older in Albania, equally distributed into two cohorts, exposed or nonexposed to montelukast usage, matched by age and gender according to information reported in the data collection. Patients with a previous history of myocardial infarction or ischemic stroke were excluded. In summary, 37 (4.6%) of the asthmatic patients, 32 nonexposed, and five exposed to montelukast suffered a major cardiovascular event during the 3-year observation period. All the cardiovascular events, in either group, occurred among patients with an increased cardiovascular risk. Our analyses demonstrate that, independent from gender, exposure to montelukast remained a significant protective factor for incident ischemic events (78% or 76% risk reduction depending on type of analysis). The event-free Kaplan–Meier survival curves confirmed the lower cardiovascular event incidence in patients exposed to montelukast. Our data suggest that there is a potential preventative role of montelukast for incident cardiac ischemic events in the older asthmatic population, indicating a comorbidity benefit of montelukast usage in asthmatics by targeting cysteinyl leukotriene-driven cardiac disease inflammation.
Highlights
Inflammation is a physiological reaction that, when dysregulated, can become a pathological process associated with several diseases characterized by the release of mediators, including metabolites of arachidonic acid
77.7% (108/139) of our asthmatic groups were exposed to montelukast, compared to only 44.2% of urban patients (292/661)
In asthmatic patients with a lower education, only 28.1% were exposed to montelukast (68/ 242), compared to 59.5% with mid- to high level education (332/ 558)
Summary
Inflammation is a physiological reaction that, when dysregulated, can become a pathological process associated with several diseases characterized by the release of mediators, including metabolites of arachidonic acid. Cysteinyl leukotrienes (cysteinyl-LTs), namely, LTC4, LTD4, and LTE4, are derived from arachidonic acid and are potent proinflammatory lipid mediators well-known to play an important role in asthma (Nicosia et al, 2001), and that have been implicated in other inflammatory conditions, such as allergic rhinitis (AR), atopic dermatitis, and urticaria (Capra et al, 2007). Increased intracoronary production of cysteinyl-LTs was detected in patients undergoing coronary angioplasty (Brezinski et al, 1992) and by systemic urinary LTE4 excretion in acute MI and ischemic heart disease patients (Carry et al, 1992; Allen et al, 1993; De Caterina et al, 2010). Besides the increase in cysteinyl-LTs concentration in CVD, a number of genetic studies support a link between cysteinylLTs, their receptors, and CVD (Helgadottir et al, 2004; Iovannisci et al, 2007; Bevan et al, 2009; Freiberg et al, 2010)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
