Lupus Leads Inflammatory Disorders in Cardiometabolic Risk

The risk of cardiometabolic events is high in inflammatory disorders, especially systemic lupus erythematosus, a recent study showed. The events may vary by anti-inflammatory therapy and duration.

All-cause mortality also was higher in patients who had systemic lupus erythematosus or another specific inflammatory disorder than in those who had no inflammatory disorder.

The relationship between inflammatory disorders with cardiometabolic diseases and mortality within a community-based population was assessed by researchers at King’s College London, London, and the National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas NHS Foundation Trust, also in London.

They used UK Biobank data to conduct a cross-sectional study to estimate cardiometabolic risk and a prospective cohort study to estimate mortality risk.

Binary regression analyses helped model the association between coronary heart disease, stroke, type 2 diabetes, venous thromboembolism, and peripheral artery disease diagnoses with the following inflammatory disorders: rheumatoid arthritis, systemic lupus erythematosus, psoriasis, ankylosing spondylitis, systemic vasculitis, Crohn disease, and ulcerative colitis.

The researchers reported their findings in Heart.

Some key points:

• Multiple cardiometabolic diseases were more common among systemic lupus erythematosus and vasculitis disorders and less common with Crohn disease and psoriasis disorders.

• Participants with a diagnosis of systemic lupus erythematosus presented the highest rates of cardiometabolic events, except for type 2 diabetes, which was more common among participants reporting rheumatoid arthritis, vasculitis, or psoriasis disorders.

• Patients with a systemic lupus erythematosus diagnosis presented a 6-fold adjusted increased risk of multiple cardiometabolic events.

• Systemic lupus erythematosus showed the strongest association with multiple risk of cardiometabolic diseases, followed by rheumatoid arthritis, ulcerative colitis, ankylosing spondylitis, vasculitis, and psoriasis.

• The magnitude of the association was greater in participants who were prescribed NSAIDs or corticosteroids. Patients with a diagnosis of systemic lupus erythematosus presented a 12-fold adjusted increased risk of multiple cardiometabolic events compared with those who did not have an inflammatory disorder. Multiple cardiometabolic risk also was greater within ulcerative colitis, Crohn disease, rheumatoid arthritis, psoriasis, ankylosing spondylitis, and vasculitis. A similar pattern was observed with respect to the cumulative cardiometabolic risk.

• Patients with a diagnosis of systemic lupus erythematosus presented with the highest adjusted hazard ratio of all-cause mortality compared with the comparison group.

The study authors called for early screening and regular monitoring of cardiometabolic risk in patients with systemic lupus erythematosus and other inflammatory disorders.

“For some inflammatory disorders, the increased risk was detectable early in the course of the disorder, supporting the public health value of early screening and effective intervention strategy,” they noted. “Recent evidence from primary care data suggests that we are falling short of this suggestion.”

“The findings of increased cardiometabolic risks associated with NSAIDs and/or corticosteroids drugs reinforce the need for a more cautionary approach to the prescription of these drugs,” they added.

“The evidence that cardiometabolic risk varied with anti-inflammatory therapy endorses future evaluations into the potential role of specific DMARDs (alone or in combination with vascular risk therapies [ie, statins]) into the onset and prognosis of cardiometabolic events within a specific inflammatory disorder.”

References:

Dregan A, Chowienczyk P, Molokhia M. “Cardiovascular and type 2 diabetes morbidity and all-cause mortality among diverse chronic inflammatory disorders.” Heart. 2017 Jun 10. pii: heartjnl-2017-311214. doi: 10.1136/heartjnl-2017-311214. [Epub ahead of print]