Abstract
BackgroundThere is accumulating evidence for an increased cardiovascular burden in inflammatory arthritis, but the true magnitude of this cardiovascular burden is still debated. We sought to determine the prevalence rate of non-fatal cardiovascular disease (CVD) in inflammatory arthritis, diabetes mellitus and osteoarthritis (non-systemic inflammatory comparator) compared to controls, in primary care.MethodsData on CVD morbidity (ICPC codes K75 (myocardial infarction), K89 (transient ischemic attack), and/or K90 (stroke/cerebrovascular accident)) from patients with inflammatory arthritis (n = 1,518), diabetes mellitus (n = 11,959), osteoarthritis (n = 4,040) and controls (n = 158,439) were used from the Netherlands Information Network of General Practice (LINH), a large nationally representative primary care based cohort. Data were analyzed using multi-level logistic regression analyses and corrected for age, gender, hypercholesterolemia and hypertension.ResultsCVD prevalence rates were significantly higher in inflammatory arthritis, diabetes mellitus and osteoarthritis compared with controls. These results attenuated - especially in diabetes mellitus - but remained statistically significant after adjustment for age, gender, hypertension and hypercholesterolemia for inflammatory arthritis (OR = 1.5 (1.2-1.9)) and diabetes mellitus (OR = 1.3 (1.2-1.4)). The association between osteoarthritis and CVD reversed after adjustment (OR = 0.8 (0.7-1.0)).ConclusionsThese results confirm an increased prevalence rate of CVD in inflammatory arthritis to levels resembling diabetes mellitus. By contrast, lack of excess CVD in osteoarthritis further suggests that the systemic inflammatory load is critical to the CVD burden in inflammatory arthritis.
Highlights
There is accumulating evidence for an increased cardiovascular burden in inflammatory arthritis, but the true magnitude of this cardiovascular burden is still debated
Individuals with inflammatory arthritis, diabetes mellitus and osteoarthritis were more often female and used significantly more statins and anti-hypertensive agents compared with the control group
The association between osteoarthritis and cardiovascular disease (CVD) reversed after adjustment for age, gender and CVD risk factors (OR = 0.8)
Summary
There is accumulating evidence for an increased cardiovascular burden in inflammatory arthritis, but the true magnitude of this cardiovascular burden is still debated. Chronic inflammation either directly or indirectly via insulin resistance, endothelial dysfunction, and dyslipidaemia, The true magnitude of the cardiovascular burden in inflammatory arthritis is still debated, since outcomes of studies assessing CVD prevalence and incidence are difficult to compare due to differences in study design and study populations. Most studies are performed in secondary care-based cohorts and only a minority in community-based settings, which, as a consequence, may lead to an overestimation of the CVD burden due to an overrepresentation of inflammatory arthritis patients with more severe disease [1,7,8]. This problem can be solved by using data from electronic medical records (EMRs) from general practitioners (GPs). All Dutch inhabitants are listed with a general practice, and the GP is the first professional to be consulted for health problems
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