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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