Comparative Risk of Incident Coronary Heart Disease Across Chronic Inflammatory Diseases

Abstract

Background: Chronic inflammatory diseases (CIDs) are considered risk enhancing factors for coronary heart disease (CHD). However, sparse data exist regarding relative CHD risks across CIDs.Objective: Determine relative differences in CHD risk across multiple CIDs: psoriasis, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), human immunodeficiency virus (HIV), systemic sclerosis (SSc), and inflammatory bowel disease (IBD).Methods: The cohort included patients with CIDs and controls without CID in an urban medical system from 2000 to 2019. Patients with CIDs were frequency-matched with non-CID controls on demographics, hypertension, and diabetes. CHD was defined as myocardial infarction (MI), ischemic heart disease, and/or coronary revascularization based on validated administrative codes. Multivariable-adjusted Cox models were used to determine the risk of incident CHD and MI for each CID relative to non-CID controls. In secondary analyses, we compared CHD risk by disease severity within each CID.Results: Of 17,049 patients included for analysis, 619 had incident CHD (202 MI) over an average of 4.4 years of follow-up. The multivariable-adjusted risk of CHD was significantly higher for SLE [hazard ratio (HR) 1.9, 95% confidence interval (CI) 1.2, 3.2] and SSc (HR 2.1, 95% CI 1.2, 3.9). Patients with SLE also had a significantly higher risk of MI (HR 3.6, 95% CI 1.9, 6.8). When CIDs were categorized by markers of disease severity (C-reactive protein for all CIDs except HIV, for which CD4 T cell count was used), greater disease severity was associated with higher CHD risk across CIDs.Conclusions: Patients with SLE and SSc have a higher risk of CHD. CHD risk with HIV, RA, psoriasis, and IBD may only be elevated in those with greater disease severity. Clinicians should personalize CHD risk and treatment based on type and severity of CID.

Phenotypic Presentations of Heart Failure Among Patients With Chronic Inflammatory Diseases

“…Whether these differences reflect unique heart-lung physiology and fibrotic mediators arising in SSc warrants further study. Moreover, although several CIDs (including HIV, RA, and SLE) are associated with heightened atherothrombotic risk, HF patients with HIV had an especially high prevalence of underlying CAD; this adds to recently reported data revealing a higher rate of CAD in patients with SLE and SSc ( 33 ), and substantiates prior reports highlighting HIV's association with acute coronary syndrome ( 34 ).…”

Microvascular Density Analysis of Patients with Inactive Systemic Lupus Erythematosus—A Two-Year Follow-Up Optical Coherence Tomography Angiography Study

“…Vascular disease is frequent in patients with SLE, and it is the major cause of death-established SLE. Vascular disease in SLE can manifest as accelerated atherosclerosis predisposing to coronary artery disease and renal disease, which are major causes of mortality [34,35]. HCQ therapy is the standard treatment for SLE, which can lead to HCQ-induced maculopathy as one of the most serious complications.…”

Crohn’s disease in human immunodeficiency virus-infected patient: A case report

“…Speaking of the observed complications, interestingly, a previous study reported that inflammatory diseases promote coronary heart diseases; however, for HIV and IBD, this only occurs when the illnesses are severe[ 1 ]. Our patient had PE, which could also have been caused by the corticosteroids prescribed after her first exacerbation.…”

“…It is classified as either ulcerative colitis (UC) or Crohn’s disease (CD). Both IBD and HIV infection can coexist in the same person, although this coexistence is rarely observed; therefore, the relationship between one and the other and the impact of this relationship on the immune system are not fully understood yet[ 1 , 2 ]. However, there are speculations that the HIV-modified CD4 + lymphocyte count plays its role in altering the course of IBD alongside increasing the likelihood of opportunistic infections occurring[ 2 , 3 ].…”