What is the clinical evidence from this study?

Study design: Cohort. Population: Asthma and cardiovascular disease (n=16807). Primary outcome: New-onset cardiovascular disease associated with baseline asthma (HR 1.746, 95% CI 1.351-2.256, p=<0.001).

What does this research mean for the field?

There is a bidirectional association between asthma and cardiovascular disease in middle-aged and older Chinese adults, where baseline asthma increases the risk of new-onset cardiovascular disease by 74.6%, and frailty partially mediates the pathway from cardiovascular disease to incident asthma. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 16, 2026Open Access

Bidirectional association between asthma and cardiovascular disease in middle-aged and older Chinese adults: the mediating effect of frailty

Q: What are the key findings of this study?

Baseline asthma correlated with a 74.6% heightened risk of new-onset cardiovascular disease (HR 1.746) in middle-aged and older Chinese adults.

Q: What does this research mean for the field?

There is a bidirectional association between asthma and cardiovascular disease in middle-aged and older Chinese adults, where baseline asthma increases the risk of new-onset cardiovascular disease by 74.6%, and frailty partially mediates the pathway from cardiovascular disease to incident asthma. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

This research aims to explore the bidirectional relationship between asthma and cardiovascular disease, focusing on frailty as a mediator.

Key Result

Baseline asthma correlated with a 74.6% heightened risk of new-onset cardiovascular disease (HR 1.746) in middle-aged and older Chinese adults.

Key Points

This research aims to explore the bidirectional relationship between asthma and cardiovascular disease, focusing on frailty as a mediator.
Utilized longitudinal data from the China Health and Retirement Longitudinal Study (2011–2018)
Analyzed cohorts of CVD-free and asthma-free participants
Evaluated frailty using a 29-component frailty index
Employed Cox proportional hazards regression models for bidirectional associations
Conducted mediation analysis with bootstrap methods to assess frailty's role.
Baseline asthma increases risk of new-onset cardiovascular disease by 74.6% (HR = 1.746) after adjustments
Baseline cardiovascular disease increases the risk of developing asthma by 62.1% (HR = 1.621)
Frailty accounted for 15.57% of the relationship between cardiovascular disease and asthma
Mediation analysis indicated frailty did not mediate the opposite pathway.
Effects were consistent across demographic and clinical subgroups.

Study Design

Type

Cohort (n=16,807)

Multicenter

Structured PICO

Does baseline asthma increase the risk of incident cardiovascular disease, and does baseline cardiovascular disease increase the risk of incident asthma in middle-aged and older adults?

Population

Middle-aged and older Chinese adults (≥45 years) from the China Health and Retirement Longitudinal Study (CHARLS). Two cohorts were analyzed: 7,910 CVD-free participants (for incident CVD analysis) and 8,897 asthma-free participants (for incident asthma analysis).

Intervention

Baseline asthma (for Phase I analysis) or baseline cardiovascular disease (for Phase II analysis)

Comparator

No baseline asthma (Phase I) or no baseline cardiovascular disease (Phase II)

Outcome

Incident cardiovascular disease (defined as cardiac disease and stroke) or incident asthma over a 7-year follow-uphard clinical

There is a significant bidirectional association between asthma and cardiovascular disease in middle-aged and older Chinese adults, with frailty partially mediating the pathway from cardiovascular disease to asthma.

Main Result

Effect estimate: HR 1.746 (95% CI 1.351-2.256)

p-value: p=<0.001

Limitations

Use of self-reported diagnosis for asthma and CVD may introduce bias.
Longitudinal study design may have confounding variables that were not completely controlled.

Abstract

The bidirectional relationship between asthma and cardiovascular disease (CVD) among aging populations remains insufficiently explored, especially regarding potential mediating mechanisms. The objective of this study is to explore the bidirectional effects between asthma and CVD, with focus on frailty as a potential mediator. We utilized longitudinal data (2011–2018) from the China Health and Retirement Longitudinal Study (CHARLS) to analyze two cohorts: 7,910 CVD-free participants and 8,897 asthma-free participants. Frailty was evaluated based on a 29-component frailty index (FI). Bidirectional associations were examined using Cox proportional hazards regression models, with progressive adjustments for sociodemographic, lifestyle, and clinical variables. Mediation analysis assessed the mediating role of FI, utilizing bootstrap methods. baseline asthma correlated with a 74.6% heightened risk of new-onset CVD (HR = 1.746, 95% CI: 1.351–2.256) after full adjustment, whereas baseline CVD correlated with a 62.1% heightened risk of developing incident asthma (HR = 1.621, 95% CI: 1.207–2.176). Bidirectional associations were examined using Cox regression models. FI accounted for 15.57% of the relationship between CVD and asthma, as indicated by the mediation analysis (indirect effect = 0.005, 95% CI: 0.002–0.007), but did not mediate the opposite pathway. Subgroup analyses revealed consistent effects across demographic and clinical subgroups (all interaction p > 0.05). This research offers new insights into bidirectional associations between asthma and CVD in older Chinese adults, with partial mediation by frailty in the CVD→ asthma pathway. Findings highlight the need for integrated management and suggest frailty may serve as a target for intervention.

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