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Cardiac risk factors and prevention
Original research article
Cardiovascular and type 2 diabetes morbidity and all-cause mortality among diverse chronic inflammatory disorders
  1. Alex Dregan1,2,
  2. Phil Chowienczyk3,
  3. Mariam Molokhia1,2
  1. 1 Department of Primary Care and Public Health Sciences, King’s College London, London, UK
  2. 2 National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas NHS Foundation Trust, London, UK
  3. 3 British Foundation Centre, King’s College London, London, UK
  1. Correspondence to Dr Alex Dregan, Department of Primary Care and Public Health Sciences, King’s College London, 3rd Floor Addison House, London, SE1 1UL, UK; alexandru.dregan{at}kcl.ac.uk

Abstract

Objectives The present study aimed to assess the relationship between inflammatory disorders with cardiometabolic diseases and mortality within a community-based population.

Methods The UK Biobank data were used to conduct two investigations: a cross-sectional study to estimate cardiometabolic risk and a prospective cohort study to estimate mortality risk. Binary regression analyses were used to model the association between coronary heart disease, stroke, type 2 diabetes, venous thromboembolism and peripheral artery disease diagnoses with seven inflammatory disorders (eg, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriasis, ankylosing spondylitis (AS), systemic vasculitis, Crohn’s disease and ulcerative colitis (UC)). Cox proportional hazards was used to estimate all-cause and cardiovascular-related mortality.

Results About 4% (n=19, 082) of the study population (n=5 02 641) were diagnosed with a chronic inflammatory disorder. The most common inflammatory disorder was psoriasis (n=6286), and the least common was SLE (n=654). SLE showed the strongest association with multiple (relative risk (RR) 6.36, 95% CI 4.37 to 9.25) risk of cardiometabolic diseases, followed by the RA (RR 1.70, 95% CI 1.59 to 1.83), UC (RR 1.69, 95% CI 1.51 to 1.89), AS (RR 1.28, 95% CI 1.09 to 1.52), vasculitis (RR 1.64, 95% CI 1.42–1.90) and psoriasis (RR 1.25, 95% 1.16 to 1.35) disorders. The magnitude of the association was higher among participants prescribed non-steroidal anti-inflammatory drugs or corticosteroids drugs, with multiple cardiometabolic risk being greater within SLE (RR 12.35, 95% CI 7.18 to 21.24), followed by UC (RR 3.81, 95% CI 2.69 to 5.38), Crohn’s disease (RR 3.07, 95% CI 1.85 to 5.11), RA (RR 3.06, 95% CI 2.44 to 3.85), psoriasis (RR 2.36, 95% CI 1.88 to 2.95), AS (RR 2.25, 95% CI 1.48 to 3.41) and vasculitis (RR 1.89, 95% CI 1.28 to 2.79). Similar pattern was observed with respect to the cumulative cardiometabolic risk.

Conclusion Inflammatory disorders are associated with heightened risk of cardiometabolic events, which may vary by anti-inflammatory therapy and duration. All-cause mortality was also higher among specific inflammatory disorders compared with the absence of inflammatory disorders.

  • Cardiac risk factors and prevention
  • Coronary artery disease
  • Stroke
  • Systemic inflammatory diseases
  • Diabetes

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/heartjnl-2017-311214

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    Footnotes

    • Contributors All authors have contributed to the design and development of the study. AD has obtained and analysed the data. AD drafted the paper, and MM and PC commented on the draft. All authors contributed to the interpretation of study findings and approved the final version of the study.

    • Funding AD, PC and MM are supported by the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London.

    • Disclaimer The views expressed are those of the author(s) and not necessarily those of the National Health Service, the National Institute of Health Research or the Department of Health.

    • Competing interests None declared.

    • Ethics approval Northwestern Regional Development Agency.

    • Provenance and peer review Not commissioned; externally peer reviewed.