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Grand Rounds

Is Autoimmune Disease Associated with an Increased Risk for Cardiovascular Disease?

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BACKGROUND AND PURPOSE:

  • Previous studies have suggested a link between autoimmune disease and increased risk for cardiovascular disease (CVD)
  • Conrad et al. (The Lancet, 2022) assessed the association between autoimmune disorders and CVD risk

METHODS:

  • Population-based study
    • Primary and secondary care records obtained from datasets across the UK
  • Population
    • Any of 19 autoimmune diseases diagnosed between 2000 and 2017
    • <80 years at time of diagnosis
    • No CVD up to 12 months after diagnosis
  • Exposures
    • Autoimmune disease
    • Controls: Cohort (up to 5 individuals free of autoimmune and CVD) matched for age, sex, socioeconomic status, region, and calendar year
  • Study design
    • Follow-up was through June 2019
    • Cox proportional hazards models used to examine differences in patients with and without autoimmune diseases
  • Primary outcome
    • Incidence of 12 cardiovascular outcomes

RESULTS:

  • Individuals with autoimmune disease
    • 446,449 | Matched controls: 2,102,830
    • Mean age at autoimmune disease diagnosis: 46.2 years | 60.8% women
  • CVD diagnoses
    • Autoimmune disease cohort: 15.3%
    • Control cohort: 11.0%
    • Median 6.2 (IQR, 2.7 to 10.8) years of follow-up
  • The incidence rate of CVD was higher for people with autoimmune disease
    • Autoimmune disease cohort: 23.3 events per 1000 patient-years
    • Control cohort: 15.0 events per 1000 patient-years
    • Hazard ratio (HR) 1.56 (95% CI, 1.52 to 1.59)
  • An increased risk of cardiovascular disease with autoimmune disease was seen for every individual cardiovascular disease
  • This risk increased progressively with
    • The number of autoimmune diseases present
      • 1 disease: HR 1.41 (95% CI, 1.37 to 1.45)
      • 2 diseases: HR 2.63 (95% CI, 2.49 to 2.78)
      • ≥3 diseases: HR 3.79 (95% CI, 3.36 to 4.27)
    • Younger age at time of diagnosis
      • Age <45 years: HR 2.33 (95% CI, 2.16 to 2.51)
      • Age 55 to 64 years: HR 1.76 (95% CI, 1.67 to 1.85)
      • Age ≥75 years: HR 1.30 (95% CI, 1.24 to 1.36)
  • Among autoimmune diseases, those with the highest overall CVD risk were
    • Systemic sclerosis: HR 3.59 (95% CI, 2.81 to 4.59)
    • Addison’s disease: HR 2.83 (95% CI, 1.96 to 4.09)
    • Systemic lupus erythematosus: HR 2.82 (95% CI, 2.38 to 3.33)

CONCLUSION:

  • Autoimmune diseases were associated with an increased risk for cardiovascular disease
  • Effect more pronounced for patients diagnosed with autoimmune disease earlier in life, and those with multiple autoimmune diseases
  • The authors state

The substantial cardiovascular risk observed in patients with autoimmune diseases, particularly in younger age groups, suggests that strategies to reduce cardiovascular risk should become a routine part of autoimmune disease management

Learn More – Primary Sources:

Autoimmune diseases and cardiovascular risk: a population-based study on 19 autoimmune diseases and 12 cardiovascular diseases in 22 million individuals in the UK

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