RT Journal Article
SR Electronic
T1 Association between chronic immune-mediated inflammatory diseases and cardiovascular risk
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 119
OP 126
DO 10.1136/heartjnl-2017-311279
VO 104
IS 2
A1 Jose Miguel Baena-Díez
A1 Maria Garcia-Gil
A1 Marc Comas-Cufí
A1 Rafel Ramos
A1 Daniel Prieto-Alhambra
A1 Betlem Salvador-González
A1 Roberto Elosua
A1 Irene R Dégano
A1 Judith Peñafiel
A1 María Grau
YR 2018
UL http://heart.bmj.com/content/104/2/119.abstract
AB 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.