Abstract

Background: Chronic inflammatory diseases (CIDs) are considered risk enhancing factors for coronary heart disease (CHD). However, sparse data exist regarding relative CHD risks across CIDs.Objective: Determine relative differences in CHD risk across multiple CIDs: psoriasis, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), human immunodeficiency virus (HIV), systemic sclerosis (SSc), and inflammatory bowel disease (IBD).Methods: The cohort included patients with CIDs and controls without CID in an urban medical system from 2000 to 2019. Patients with CIDs were frequency-matched with non-CID controls on demographics, hypertension, and diabetes. CHD was defined as myocardial infarction (MI), ischemic heart disease, and/or coronary revascularization based on validated administrative codes. Multivariable-adjusted Cox models were used to determine the risk of incident CHD and MI for each CID relative to non-CID controls. In secondary analyses, we compared CHD risk by disease severity within each CID.Results: Of 17,049 patients included for analysis, 619 had incident CHD (202 MI) over an average of 4.4 years of follow-up. The multivariable-adjusted risk of CHD was significantly higher for SLE [hazard ratio (HR) 1.9, 95% confidence interval (CI) 1.2, 3.2] and SSc (HR 2.1, 95% CI 1.2, 3.9). Patients with SLE also had a significantly higher risk of MI (HR 3.6, 95% CI 1.9, 6.8). When CIDs were categorized by markers of disease severity (C-reactive protein for all CIDs except HIV, for which CD4 T cell count was used), greater disease severity was associated with higher CHD risk across CIDs.Conclusions: Patients with SLE and SSc have a higher risk of CHD. CHD risk with HIV, RA, psoriasis, and IBD may only be elevated in those with greater disease severity. Clinicians should personalize CHD risk and treatment based on type and severity of CID.

Highlights

  • Individuals living with chronic inflammatory diseases (CIDs) have an increased risk of coronary heart disease (CHD) and myocardial infarction (MI) [1, 2]

  • There were differences in risk factors: patients with rheumatoid arthritis (RA), systemic sclerosis (SSc), and systemic lupus erythematosus (SLE) had higher baseline rates of hypertension; patients with RA and psoriasis had higher baseline rates of diabetes; and the human immunodeficiency virus (HIV) cohort had the highest prevalence of active smokers

  • We investigated associations of levels of inflammation within CID groups with risk of incident CHD and MI

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Summary

Introduction

Individuals living with chronic inflammatory diseases (CIDs) have an increased risk of coronary heart disease (CHD) and myocardial infarction (MI) [1, 2]. In primary prevention guidelines from the European Society of Cardiology and American Heart Association, certain CIDs such as psoriasis, rheumatoid arthritis (RA), human immunodeficiency virus (HIV), and systemic lupus erythematosus (SLE) are recognized as risk-enhancing factors for atherosclerotic cardiovascular disease (ASCVD) [3, 4]. Emerging data suggest that CHD risk is elevated in other CIDs such as systemic sclerosis (SSc) and inflammatory bowel disease (IBD) [5,6,7]. The degree of risk factor modification for primary prevention should match the risk of CHD based on CID type and severity. Chronic inflammatory diseases (CIDs) are considered risk enhancing factors for coronary heart disease (CHD). Sparse data exist regarding relative CHD risks across CIDs

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