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CV risk reduction should be ‘routine part’ of autoimmune disease management

By Claire Barnard, medwireNews Reporter

People with autoimmune diseases, particularly those with systemic sclerosis (SSc), Addison’s disease or systemic lupus erythematosus (SLE), have a substantially elevated risk of cardiovascular disease (CVD) that should be reflected in their routine care, suggest findings from a large study published in The Lancet.

In their analysis of UK medical records from 2000–2017, Nathalie Conrad (KU Leuven, Belgium) and team found that among 446,449 people with autoimmune diseases who were younger than 80 years at diagnosis and free from CVD for the following year, 15.3% developed incident CVD over a median follow-up of 6.2 years, giving an incidence rate of 23.3 per 1000 person–years.

By comparison, 11.0% of 2,102,830 matched controls without autoimmune disease developed CVD, for an incidence rate of 15.0 per 1000 person–years.

Conrad et al say that these findings translated into a significant 1.56-fold higher risk of CVD among people with versus without autoimmune diseases, “an order of magnitude that is similar to the risk caused by type 2 diabetes.”

When the 19 autoimmune diseases studied were evaluated separately, all were significantly associated with increased CVD risk, suggesting that “autoimmunity per se, rather than any individual condition, is the risk factor and that the potential contribution of these diseases to cardiovascular disease in the population is far greater than previously recognised”, remark the researchers.

However, they demonstrated that the magnitude of increased risk varied by autoimmune disease, with the greatest risk increase seen among people with SSc (hazard ratio [HR]=3.59), Addison’s disease (HR=2.83) or SLE (HR=2.82). The lowest risk increase was seen in those with vitiligo (HR=1.38).

“Importantly, the observed excess cardiovascular risk with autoimmune disease was not explained by traditional cardiovascular risk factors, such as age, sex, socioeconomic status, blood pressure, BMI, smoking, type 2 diabetes, or cholesterol”, write Conrad et al.

The team also found that the elevated risk of CVD “increased progressively with the number of autoimmune diseases present”, with HRs ranging from 1.41 for one condition to 3.79 for three or more. The association was stronger in people younger than 45 years of age (HR=2.33) compared with older individuals (HR=1.30 for those aged 75 years and older), and people with autoimmune diseases developed CVD at a younger age on average than those without (67.7 vs 70.4 years).

Taken together, these findings “have important implications for healthcare resource planning and preventive strategies”, say the study authors.

“The substantial cardiovascular risk observed in patients with autoimmune diseases, particularly in younger age groups, suggests that strategies to reduce cardiovascular risk should become a routine part of autoimmune disease management”, they add.

Writing in an accompanying comment, Paul Ridker (Brigham and Women’s Hospital, Boston, Massachusetts, USA) believes that “the size and breadth of these data command our attention”, noting that the “substantial cardiovascular risk” associated with autoimmune diseases “can no longer be ignored by the clinical community.”

He highlights that “guidelines for cardiovascular disease prevention in Europe need to directly address the role of autoimmune diseases and the use of inflammatory biomarkers such as high sensitivity C-reactive protein in detection of cardiovascular disease—steps already taken in the USA and Canada.”

Ridker advises that “careful consideration should be given to randomised trial data obtained in the general population that might inform therapy [to reduce CVD risk] among individuals with autoimmune diseases.”

And he suggests “[a] good place to start would be increased use of lipid-lowering therapies.”

News stories are provided by medwireNews, which is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group

Lancet 2022; 400: 733–743

Lancet 2022; 400: 708–710