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Original research article
Association between chronic immune-mediated inflammatory diseases and cardiovascular risk
  1. Jose Miguel Baena-Díez1,2,3,
  2. Maria Garcia-Gil4,5,6,
  3. Marc Comas-Cufí4,5,
  4. Rafel Ramos4,5,6,7,
  5. Daniel Prieto-Alhambra8,9,
  6. Betlem Salvador-González1,10,
  7. Roberto Elosua1,
  8. Irene R Dégano1,
  9. Judith Peñafiel1,
  10. María Grau1,11
  1. 1 Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
  2. 2 La Marina Primary Care Centre and Primary Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain
  3. 3 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Barcelona, Spain
  4. 4 Primary Care Research Institute Jordi Gol, Girona, Spain
  5. 5 Research Unit in Primary Care, Primary Care Services Girona, Catalan Institute of Health (ICS), Girona, Spain
  6. 6 Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
  7. 7 Biomedical Research Institute, Girona, Spain
  8. 8 Musculoskeletal Diseases Research Group (GREMPAL), Primary Care Research Institute Jordi Gol, Universitat Autònoma de Barcelona, Barcelona, Spain
  9. 9 Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Musculoskeletal Pharmaco- and Device Epidemiology, University of Oxford, Oxford, UK
  10. 10 Florida Sud Primary Care Centre and Primary Care Research Institute Jordi Gol, Catalan Institute of Health, L’Hospitalet de Llobregat, Barcelona, Spain
  11. 11 University of Barcelona, Barcelona, Spain
  1. Correspondence to Dr María Grau, Cardiovascular Epidemiology & Genetics, IMIM, Dr Aiguader 88, Barcelona 08030, Spain; mgrau{at}


Objective To examine the association between chronic immune-mediated diseases (rheumatoid arthritis, systemic lupus erythematosus or the following chronic immune-mediated inflammatory diagnoses groups: inflammatory bowel diseases, inflammatory polyarthropathies, systemic connective tissue disorders and spondylopathies) and the 6-year coronary artery disease, stroke, cardiovascular disease incidence and overall mortality; and to estimate the population attributable fractions for all four end-points for each chronic immune-mediated inflammatory disease.

Methods Cohort study of individuals aged 35–85 years, with no history of cardiovascular disease from Catalonia (Spain). The coded diagnoses of chronic immune-mediated diseases and cardiovascular diseases were ascertained and registered using validated codes, and date of death was obtained from administrative data. Cox regression models for each outcome according to exposure were fitted to estimate HRs in two models1: after adjustment for sex, age, cardiovascular risk factors and2 further adjusted for drug use. Population attributable fractions were estimated for each exposure.

Results Data were collected from 991 546 participants. The risk of cardiovascular disease was increased in systemic connective tissue disorders (model 1: HR=1.38 (95% CI 1.21 to 1.57) and model 2: HR=1.31 (95% CI 1.15 to 1.49)), rheumatoid arthritis (HR=1.43 (95% CI 1.26 to 1.62) and HR=1.31 (95% CI 1.15 to 1.49)) and inflammatory bowel diseases (HR=1.18 (95% CI 1.06 to 1.32) and HR=1.12 (95% CI 1.01 to 1.25)). The effect of anti-inflammatory treatment was significant in all instances (HR=1.50 (95% CI 1.24 to 1.81); HR=1.47 (95% CI 1.23 to 1.75); HR=1.43 (95% CI 1.19 to 1.73), respectively). The population attributable fractions for all three disorders were 13.4%, 15.7% and 10.7%, respectively.

Conclusion Systemic connective tissue disorders and rheumatoid arthritis conferred the highest cardiovascular risk and population impact, followed by inflammatory bowel diseases.

  • Cardiovascular disease
  • Inflammation
  • Arthritis
  • Connective Tissue Diseases
  • Inflammatory Bowel Diseases
  • Spondyloarthritis

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  • Contributors JMBD, MGG, MCC, RR and MG conceived and designed the study. JMBD, MGG, MCC, RR, DPA, RE and MG acquired, analysed and interpreted the data. JMBD, BSG, IRD and MG drafted the manuscript. MGG, MCC and JP carried out the statistical analysis. JMBD and MG supervised the study. MG had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This work has been supported by grants from the Instituto de Salud Carlos III FEDER (CP12/03287; HERACLES RD12/0042; RedIAPP RD12/0005), AGAUR (2014 SGR 240). IRD was funded by the RECERCAIXA Program, ObraSocial ‘La Caixa’ (RE087465).

  • Competing interests None declared.

  • Patient consent This manuscript is based on electronic medical records review.

  • Ethics approval CEIC PSMAR.

  • Provenance and peer review Not commissioned; externally peer reviewed.