Changes in proportionate cardiovascular mortality in patients with chronic infectious and inflammatory conditions in the United States, 1999–2018

Abstract

Treatment options for several chronic infectious and inflammatory conditions have expanded in recent years. This may have implications for evolving competing risks for chronic inflammation-associated comorbidities, including cardiovascular diseases (CVDs). Yet sparse data exist on patterns over time in cardiovascular mortality for chronic infectious and inflammatory conditions. We used data from the Centers for Disease Control and Prevention 1999–2018 Multiple Causes of Death database to investigate patterns in CVD mortality from January 1, 1999 to December 31, 2018 in several infectious and inflammatory conditions. Specifically, we determined age-adjusted proportionate CVD mortality separately for patients with the following conditions (as well as the general population): hepatitis C virus (HCV), human immunodeficiency virus (HIV), inflammatory bowel diseases (IBD), psoriasis (PSO), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE). Proportionate CVD mortality differed significantly in 1999 and 2018 for each condition compared with the general population (p < 0.0001). Proportionate CVD mortality decreased steadily in the general population (40.9 to 30.6%) but increased for patients with HCV (7.0 to 10.2%) and HIV (1.9 to 6.7%). For IBD, PSO, RA, and SLE, proportionate CVD mortality initially decreased followed by plateauing or increasing rates. Underlying disease-specific pathophysiologies, changes in natural history, and competing risks of chronic end-organ diseases contributing to these differences merit further study.

Impact of Inflammatory Bowel Disease (IBD) and IBD Medications on Risk of Hyperlipidemia and in vitro Hepatic Lipogenic-Related Gene Expression: A Population-Based Cohort Study

“…However, lipid profile monitoring in IBD patients is not routinely performed in Taiwan. Additionally, awareness of hyperlipidemia is lower than that of diabetes and hypertension; therefore, hyperlipidemia is diagnosed only when physical complications, such as CVD accompanied by chest pain ( 58 ). Thus, hyperlipidemia is rarely managed in patients with IBD.…”

Systematic approach to outcome assessment from coded electronic healthcare records in the DaRe2THINK NHS-embedded randomised trial

“…Code lists were supplemented after review of 27 code lists from existing published literature [31][32][33][34][35][36][37][38][39][40][41][42][43][44], with the final list of individual codes detailed in Appendix 1 Tables S24 to S44.…”

Association between chronic viral infection‐related hospitalization and risk of cardiovascular disease: A population‐based cohort study

“…Epidemiological studies have increasingly linked certain chronic viral infections with elevated risk of CVD, such as HSV, hepatitis C virus (HCV), CMV, HPV, and HIV. However, there is a significant controversy due to conflicting results from previous studies, with some reporting inverse or null association between chronic viral infection and cardiovascular outcomes 10–19 . In a cohort study involving 4809 chronic hepatitis C patients and 71 668 matched controls, no increased myocardial infarction risk was found among the infected compared to the uninfected over a median follow‐up period of 3.2 years 13 .…”

“…However, there is a significant controversy due to conflicting results from previous studies, with some reporting inverse or null association between chronic viral infection and cardiovascular outcomes. [10][11][12][13][14][15][16][17][18][19] In a cohort study involving 4809 chronic hepatitis C patients and 71 668 matched controls, no increased myocardial infarction risk was found among the infected compared to the uninfected over a median follow-up period of 3.2 years. 13 A 2022 study utilizing UK Biobank (UKB) data with 9429 participants found that seropositivity to common herpes virus was not associated with higher risk of stroke, myocardial infarction, or all-cause mortality.…”