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23-01-2020 | Cardiovascular disease | News

Comorbid autoimmune conditions amplify CVD risk in inflammatory arthritis

Claire Barnard

medwireNews: People with inflammatory arthritis (IA) have an elevated risk for cardiovascular disease (CVD), and this risk is further increased by the presence of co-existing autoimmune disorders, research suggests.

“The amplification of cardiovascular disease risk in inflammatory arthritis patients with multiple autoimmune disorders warrants greater awareness” and these findings emphasize “the need for cardiovascular risk management in these patients,” say Maaike Heslinga (Amsterdam Rheumatology and Immunology Center, the Netherlands) and study co-authors.

In their analysis of a Dutch primary care database including health records from 2010 to 2017, the team found that CVD prevalence rates were significantly higher among 28,345 patients with IA compared with 28,249 controls matched for age, sex, and treatment center, at 18.84% versus 15.50%. IA was defined as the presence of a diagnostic code for “rheumatoid arthritis and related disorders.”

These rates translated into an age- and sex-corrected odds ratio (OR) of 1.34, which rose to 1.72 for patients with IA and at least one other autoimmune disorder (type 1 diabetes, hypothyroidism, psoriasis, multiple sclerosis, or inflammatory bowel disease).

The findings were consistent when looking at different CVD subtypes, including coronary heart disease (OR=1.26 for IA only vs 1.72 for IA plus another autoimmune disorder), heart failure (OR=1.44 vs 1.88), and peripheral vascular disease (OR=1.45 vs 1.70).

And the results remained significant when the autoimmune conditions were assessed individually; patients with IA plus comorbid type 1 diabetes had the highest risk relative to controls (OR=3.55), followed by those with comorbid hypothyroidism (OR=1.81) and those with comorbid psoriasis (OR=1.66).

There was a similar pattern of results when evaluating the incidence of new CVD over a median 3.2 years of follow-up. The age- and sex- corrected hazard ratio (HR) for CVD was 1.32 for people with IA relative to controls, rising to 1.49 for those with IA plus another autoimmune disease relative to controls.

Heslinga and team also note that absolute prevalence rates of the different autoimmune diseases were higher among IA patients versus controls, including for type 1 diabetes (0.31 vs 0.17%), hypothyroidism (5.76 vs 3.97%), psoriasis (6.43 vs 2.46%), and inflammatory bowel disease (2.22 vs 0.85%).

Together, these findings “support the hypothesis that clustering of autoimmune diseases in inflammatory arthritis patients is common,” say the study authors.

They add that “[t]here are several possible explanatory mechanisms behind the increased [CVD] risk in the different autoimmune disorders, but a common denominator might be the chronic inflammatory state leading to accelerated atherosclerosis.”

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature group

Rheumatology 2020; doi:10.1093/rheumatology/kez650

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