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without authorization.
Recently, in the top medical journal Lancet.
, a survey included more than 22 million people analyzing the cardiovascular risk
of autoimmune disease patients.
The cardiovascular risk was significantly higher in patients with autoimmune disease than in the general population (23.
3 episodes per 1000 patient-years vs.
15.
0 per 1000 patient-years; HR = 1.
56 [95% CI: 1.
52–1.
59]) and a more pronounced increased risk in younger groups, suggesting that cardiovascular risk reduction should be routinely managed
for autoimmune disease.
Autoimmune diseases, such as
increased cardiovascular morbidity and mortality.
Chronic and systemic inflammation is mainly attributed to the presence of pro-inflammatory cytokines and autoantibodies, a series of autoimmune diseases with this pathophysiological feature, which together affect 5%-9% of the global population
.
At present, the impact of autoimmune diseases on cardiovascular risk, the interaction with traditional cardiovascular risk factors, and the exact underlying physiological mechanism are still highly controversial, and large-scale long-term follow-up studies are lacking to explore this topic
.
In order to fill this gap, foreign scholars collected data based on large databases and evaluated the correlation
between 19 most common autoimmune diseases and cardiovascular outcomes.
The findings were published Sept.
3 in the top medical journal Lancet
.
Research methods
Using primary and secondary care records from the Research in Clinical Practice Data Links (CPRD), GOLD and Aurum databases, this population-based study collected a group of patients in the UK who were newly diagnosed with autoimmune diseases (19 diseases) between 1 January 2000 and 31 December 2017, who were < 80 years of age at diagnosis and had no <b10>cardiovascular disease
within 1 year of diagnosis 。 A matching cohort was established in which up to five people were matched by age, sex, socioeconomic status, region, and calendar year, and matched controls were free of autoimmune and cardiovascular disease within 12 months of study entry
.
Both cohorts were followed until 30 June 2019
.
To investigate the incidence of 12 cardiovascular outcomes and use the Cox proportional hazard model to assess differences between
autoimmune diseases.
Study results
The study identified and included 22009375 general population individuals from the CPRD database, identifying 446449 eligible patients with autoimmune diseases and 2102830 matched controls
.
In the autoimmune cohort, the mean age at diagnosis was 46.
2 years (SD19.
8), of which 271,410 (60.
8%) were women and 175039 (39.
2%)
were men.
Incidence of cardiovascular disease
During the median follow-up period of 6.
2 years (IQR 2.
7-10.
8), cardiovascular disease
developed in 68,413 (15.
3%) patients with autoimmune diseases and 231,410 (11.
0%) matched controls.
The incidence of cardiovascular disease in the autoimmune cohort was 23.
3 per 1000 patient-years, significantly higher than the matched cohort of 15.
0 episodes per 1000 patient-years (hazard ratio [HR] 1.
56 [95% CI: 1.
52–1.
59]).
In subgroup analyses grouped by sex, age, socioeconomic status, and calendar year, the risk of cardiovascular disease was significantly higher in the autoimmune cohort than in the matched cohort
.
On this basis, there was no significant difference in cardiovascular disease risk between men and women, but younger individuals had a higher risk than older individuals (Figure 1).
Fig.
1 Cardiovascular disease incidence and risk ratio of autoimmune cohort and matching cohort
Risk factors for cardiovascular disease
In the autoimmune cohort, 41,902 patients (9.
3%) were diagnosed with ≥ 2 autoimmune diseases
.
The analysis showed that the risk of cardiovascular disease increased with the number of autoimmune diseases: single disease (1.
41 [1.
37 to 1.
45]); 2 diseases (2.
63 [2.
49-2.
78]); ≥ 2 diseases (3.
79 [3.
36-4.
27]).
In terms of specific conditions, patients with systemic sclerosis (3.
59 [2.
81 to 1.
59]), Addison disease (2.
83 [1.
96 to 4.
09]),
82 [2.
38 to 3.
33]), and
36 [2.
21 to 2.
52]) had the highest
risk of cardiovascular disease.
Impact of traditional cardiovascular risk factors
Traditional cardiovascular risk factors, such as
between autoimmune diseases and cardiovascular disease in the study.
In sensitivity analyses, correcting for the traditional cardiovascular risk factors described above only marginally reduced the additional risk
associated with autoimmune diseases.
Conclusion of the study
The findings of this large population-based study support evidence from previous studies that link cardiovascular disease risk to certain autoimmune diseases
.
Importantly, the observed additional cardiovascular risk of autoimmune diseases cannot be explained by traditional cardiovascular risk factors such as age, sex, blood pressure, smoking, etc
.
This finding suggests that inhibition of chronic inflammation can reduce the incidence of
cardiovascular events even without altering lipid metabolism or other risk factors.
In conclusion, a higher cardiovascular risk was observed in patients with autoimmune diseases, particularly in younger populations, suggesting that cardiovascular risk reduction should be a routine part of
autoimmune disease management.
While methods of preventing
.
References: Conrad N, Verbeke G, Molenberghs G, et al.
Autoimmune diseases and cardiovascular risk: a population-based study on 19 autoimmune diseases and 12 cardiovascular diseases in 22 million individuals in the UK[J].
Lancet.
2022 Sep 3; 400(10354):733-743.
doi: 10.
1016/S0140-6736(22)01349-6.
Epub 2022 Aug 27.
PMID: 36041475.
