Patients with autoimmune diseases more likely to develop cardiovascular disease
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Patients with autoimmune diseases may be at higher risk for cardiovascular disease than patients without autoimmune diseases, according to data published in The Lancet.
“Select autoimmune diseases, such as rheumatoid arthritis, are associated with increased cardiovascular morbidity and mortality,” Nathalie Conrad, PhD, of Katholieke Universiteit Leuven, in Belgium, and colleagues wrote. “The contribution of autoimmune diseases to cardiovascular disease in the population might extend beyond atherosclerotic diseases, such as myocardial, valvular, conduction and other cardiac complications, and venous-thromboembolic problems, and the potential effect of autoimmune diseases on the broader spectrum of cardiovascular diseases is unknown.”
To investigate the association between various autoimmune diseases and cardiovascular disease risk, Conrad and colleagues examined health records sourced from the Clinical Practice Research Datalink GOLD and Aurum databases. Patient information spanning from Jan. 1, 1985, though June 30, 2019, was included. The CPRD database is considered “broadly representative” of the United Kingdom population, the researchers wrote. Conrad and colleagues rendered a general population cohort, and from that culled an autoimmune disease cohort.
Patients in the autoimmune disease cohort were required to have one of 19 autoimmune diseases, including but not limited to ankylosing spondylitis, type 1 diabetes, Graves’ disease, inflammatory bowel disease, polymyalgia rheumatica, rheumatoid arthritis, Sjögren’s syndrome, scleroderma and systemic lupus erythematosus. The disease must have been investigated between Jan 1, 2001, and Dec. 31, 2017. Additionally, patients were required to be aged younger than 80 years at baseline and not have any cardiovascular disease for 12 months following autoimmune disease diagnosis.
A comparator cohort was organized and included “up to” five matched patients for each patient in the autoimmune cohort, the researchers wrote. The primary outcome was fatal or non-fatal cardiovascular disease, including but not limited to aortic aneurism, atrial fibrillation and flutter, and heart failure.
The analysis included 446,449 patients with autoimmune diseases and 2,102,830 matched controls. According to the researchers, 15.3% of patients with autoimmune diseases developed cardiovascular disease during follow up, compared with 11% among those without autoimmune disease. The incidence rate of cardiovascular disease among patients with autoimmune diseases was 23.3 events per 1,000 patient-years, compared with 15 events per 1,000 patient-years for those without autoimmune diseases (HR = 1.56; 95% CI, 1.52-1.59).
In addition, the risk for individual cardiovascular disease presence increased with each autoimmune disease in every individual patient, according to the researchers. For example, in patients with three or more autoimmune diseases, the HR was 3.79 (95% CI, 3.36-4.72). Meanwhile, patients with SLE (HR = 2.82; 95% CI, 2.38-3.33) and systemic sclerosis (HR = 3.59; 95% CI, 2.81-4.59) demonstrated the highest risks for developing cardiovascular disease.
“Most importantly, we found that, among 19 of the most common autoimmune diseases, all were associated with increased cardiovascular risk, indicating that autoimmunity per se, rather than any individual condition, is the risk factor and that the potential contribution of these diseases to cardiovascular disease in the population is far greater than previously recognized,” Conrad and colleagues wrote. “Yet, there is little awareness of this association and thus most patients with autoimmune disease do not receive cardiovascular prevention measures that could help reduce this burden, or undergo screening to detect cardiovascular disease.”
References:
Pujades-Rodriguez M, et al. PLoS One. 2016;doi: 10.1371/journal.pone.0151245. eCollection 2016.
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