People with autoimmune diseases may have an increased risk of cardiovascular disease

1. An increased incidence of new cardiovascular diseases has been observed in people with autoimmune disease compared to those without.

2. This increased risk was highest in younger patients and increased in patients with multiple autoimmune diseases.

Level of evidence assessment: 2 (good)

Summary of the study: Autoimmune diseases are known to be associated with cardiovascular disease. This large, longitudinal study aimed to assess the association between common autoimmune diseases and cardiovascular outcomes. Using electronic health records, the study identified people with incident autoimmune diseases over a 17-year period. For each included individual, the study identified several matched comparison patients. After a median follow-up period of 6.2 years, cardiovascular disease developed in 15.5% of individuals in the autoimmune cohort, compared with 11.0% of individuals in the comparison cohort. The risk of cardiovascular disease increased with the number of autoimmune diseases diagnosed in an individual. The risk was also higher in younger patients and those with specific autoimmune diseases, such as systemic sclerosis or Addison’s disease. Limitations of this study include the inability to control for important confounding variables such as patient medications or pre-existing risk of cardiovascular disease, including family history. Nevertheless, this study identified important populations for preventive health planning, such as younger patients with autoimmune diseases.

Click to read the study in The Lancet

Relevant Reading: Rheumatoid Arthritis and Incidence of Twelve Baseline Presentations of Cardiovascular Disease: A Population-Based Record Linkage Cohort Study in England

In depth [prospective cohort]: This study gathered a cohort of individuals from an electronic health database who were registered between January 1, 2000 and June 30, 2019. From this cohort of the general population, the study has in further identified patients with incident autoimmune disease (from a list of 19 conditions) between January 1, 2000 and December 31, 2017. Eligible participants were under the age of 80 at diagnosis and should not have cardiovascular disease until 12 months after the onset of the autoimmune disease. To avoid including patients with prior autoimmune disease, patients were excluded if they were diagnosed with autoimmunity before January 1, 2000 or within the first 12 months of registration. A randomly selected comparison group was created with individuals matched on age, timeframe, gender, socioeconomic status, and region. The primary endpoint was the presentation of cardiovascular disease (from a list of 12 conditions). A total of 446,449 patients were included in the autoimmune disease cohort with an average age at diagnosis of 46.2 years and 60.8% women. There were 2,102,830 individuals in the matched cohort. Incident cardiovascular disease developed in 68,413 (15.5%) of people in the autoimmune cohort versus 231,410 (11.0%) in the comparison group during a median follow-up period of 6 ,2 years. The incidence rate of cardiovascular disease was higher in patients with autoimmune disease than in those without (HR 1.56 [95% CI 1.52-1.59]). The risk of cardiovascular disease further increased with an increasing number of autoimmune diseases (one disease: HR 1.41; two diseases: 2.63; three or more diseases: 3.79). The risk was higher in younger patients and with specific conditions such as systemic sclerosis, Addison’s disease, systemic lupus erythematosus and type 1 diabetes.

Picture: PD

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