Cardiometabolic Event Risk Is Adversely Affected by Chronic Inflammation
Systemic lupus erythematosus had the highest association with cardiometabolic events. Image credit: ISM/Pr Jean-Denis LAREDO
Certain inflammatory disorders may increase the risk for cardiometabolic events and all-cause mortality, according to a study published in Heart.
Researchers collected data from the UK Biobank to conduct a cross-sectional study and a prospective cohort study to estimate cardiometabolic risk (including coronary heart disease, stroke, type 2 diabetes, peripheral artery disease, and venous thromboembolism) and mortality risk, respectively. Of the 502,641 participants, 19,082 were diagnosed with a chronic inflammatory disorder — rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriasis, ankylosing spondylitis, systemic vasculitis, and Crohn's disease and ulcerative colitis.
The most common disorder was psoriasis and the least common was SLE, but SLE demonstrated the strongest association with multiple cardiometabolic events (relative risk [RR] 6.36; 95% CI, 4.37-9.25). RA was associated with the next highest risk (RR 1.70; 95% CI, 1.59-1.83), followed by Crohn's disease and ulcerative colitis (RR 1.69; 95% CI, 1.51-1.89), ankylosing spondylitis (RR 1.28; 95% CI, 1.09-1.52), vasculitis (RR 1.64; 95% CI, 1.42-1.90), and psoriasis (RR 1.25; 95% CI, 1.16-1.35).
Participants who presented with SLE had the highest rates of cardiometabolic events (4%) with the exception of type 2 diabetes, which was more common in participants with RA (6%), vasculitis (6%), or psoriasis (6%). Cardiometabolic disorders often presented in one of these combinations: coronary heart disease with type 2 diabetes, coronary heart disease with venous thromboembolism, or coronary heart disease with stroke.
Furthermore, the degree of these risks appeared to be higher in participants who took nonsteroidal anti-inflammatory drugs or corticosteroid drugs. SLE still had the strongest association (RR 12.35; 95% CI, 7.18-21.24), followed by ulcerative colitis (RR 3.81; 95% CI, 2.68-5.38), Crohn's disease (RR 3.07; 2.44-3.85), psoriasis (RR 2.36; 95% CI, 1.88-2.95), ankylosing spondylitis (RR 2.25; 95% CI, 1.48-3.41), and vasculitis (RR 1.89; 95% CI, 1.28-2.79).
As the researchers pointed out, an investigation of this nature that examines both cumulative and multiple cardiometabolic risks within pathologically diverse inflammatory disorders is rarely available.
“The magnitude of the association for SLE supports the development of clinical recommendations for early screening and regular monitoring [for] cardiometabolic risk in these patients, similar to [rheumatoid arthritis] and psoriasis subgroups,” the researchers wrote.
A follow-up of the UK Biobank data is currently being conducted that will provide more substantial records of these inflammatory disorders and how they may affect patients' risk for cardiometabolic diseases.
Dregan A, Chowienczyk, Molokhia M. Cardiovascular and type 2 diabetes morbidity and all-cause mortality among diverse chronic inflammatory disorders [published June 10, 2017]. Heart. doi:10.1136/heartjnl-2017-311214