medwireNews: A large study published in The Lancet has found that people with autoimmune diseases have an approximately 1.4–3.6-fold increased risk for developing cardiovascular disease (CVD) relative to the general population.
This is “an order of magnitude that is similar to the risk caused by type 2 diabetes,” and indicates that “[c]ardiovascular risk prevention should be considered as an integral part of the management of autoimmune diseases,” say Nathalie Conrad (KU Leuven, Belgium) and colleagues.
The team analyzed medical records for 446,449 people in the UK with autoimmune diseases who were younger than 80 years at diagnosis and who did not have CVD for the first subsequent year. These people were matched to 2,102,830 controls without autoimmune diseases who had similar demographic and clinical characteristics at baseline.
Overall, 15.3% of people with autoimmune diseases developed incident CVD over a median follow-up of 6.2 years, compared with 11.0% of controls, translating into incidence rates of 23.3 versus 15.0 per 1000 person–years and a hazard ratio (HR) of 1.56.
Conrad and team note that the greatest risk increase was seen in people with systemic sclerosis (HR=3.59), primary adrenal insufficiency (HR=2.83), or systemic lupus erythematosus (HR=2.82). The HRs for other rheumatic diseases ranged from 1.47 for polymyalgia rheumatica to 2.08 for Sjögren’s syndrome, while those for other organ-specific conditions ranged from 1.38 for vitiligo to 2.36 for type 1 diabetes.
“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,” emphasize the researchers.
“[T]he potential contribution of these diseases to cardiovascular disease in the population is far greater than previously recognized,” they add.
The team also showed that CVD risk “increased progressively with the number of autoimmune diseases present,” with an HR of 1.41 for one disease, 2.63 for two, and 3.79 for three or more.
The increased risk associated with autoimmune diseases was consistent across all subgroups including by age, sex, and socioeconomic status, but the highest risk increase was seen in those aged less than 45 years (HR=2.33 vs 1.30 for those aged 75 years or older).
“These findings warrant targeted cardiovascular prevention measures, in particular in younger patients with autoimmune diseases,” say Conrad et al.
The author of an accompanying comment, Paul Ridker (Brigham and Women’s Hospital, Boston, Massachusetts, USA), believes that “[t]here are several immediate implications of these data.”
“First, guidelines for cardiovascular disease prevention in Europe need to directly address the role of autoimmune diseases and the use of inflammatory biomarkers such as high sensitivity C-reactive protein in detection of cardiovascular disease—steps already taken in the USA and Canada.”
Furthermore, “basic cardiovascular screening and prevention should become routine for most individuals with chronic inflammatory diseases,” and “careful consideration should be given to randomised trial data obtained in the general population that might inform therapy among individuals with autoimmune diseases,” he adds.
“A good place to start would be increased use of lipid-lowering therapies.”
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Lancet 2022; doi:10.1016/S0140-6736(22)01349-6
Lancet 2022; doi:10.1016/S0140-6736(22)01602-6