Chronic inflammatory diseases are associated with an increased risk of cardiovascular and metabolic events, such as stroke and diabetes, particularly for patients on corticosteroids or NSAIDs (non-steroidal anti-inflammatory drugs), a new study shows.
The study “Cardiovascular and type 2 diabetes morbidity and all-cause mortality among diverse chronic inflammatory disorders” was published in the journal Heart.
There have been many studies documenting the role of inflammation in CVD (cardiovascular disease) and the related prognosis. Patients who have chronic inflammatory diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriasis have been associated with a higher risk of many CVDs, including coronary heart disease (CHD) stroke, Type 2 diabetes, peripheral artery disease (PAD), venous thromboembolism (VTE) and CVD-related mortality.
Alex Dregan, PhD, led a research group at King’s College London that expanded on this topic by showing in a previous study there was an increased risk of CVD events associated with a range of diverse chronic inflammatory disorders, including ulcerative colitis and Crohn’s disease.
However, at the time of that study, they could not take into account socio-economic disparities between patients, and this factor is a known cause associated with the prevalence of cardiometabolic disorders. In order to account for this variable, Dregan’s group conducted another study, this time in a richer socio-economic setting, to see if their data is still applicable.
Another aim of this study was to determine whether use of corticosteroids or NSAIDs (non-steroidal anti-inflammatory drugs) was associated with a higher risk of cardiometabolic events, as that relationship has been demonstrated.
This study was conducted by analyzing data from the UK Biobank. Relative risk (RR) of event was calculated for patients, which refers the ratio of the probability of an event occurring (such as a disease) in an exposed group (in this case, patients with chronic inflammatory disease) to the probability of the event occurring in a non-exposed group (healthy subjects).
Among the people analyzed, 4% (19,082 people) were diagnosed with a chronic inflammatory disorder, with the most common one being psoriasis and RA, followed by Crohn’s disease, ulcerative colitis (UC), ankylosing spondylitis (AS), vasculitis and finally SLE. Interestingly, patients with SLE had the highest association with multiple risks of cardiometabolic diseases with a RR of 6.36, followed by RA (RR of 1.70), UC (RR of 1.69), AS (RR of 1.28), vasculitis (RR of 1.64) and psoriasis (RR of 1.25).
Consistent with literature, patients who were prescribed NSAIDs or corticosteroids had a higher association with multiple cardiometabolic risks. Furthermore, the risk of a cardiometabolic event was higher in patients on NSAIDs or corticosteroids with SLE (RR of 12.35), followed by UC patients (RR of 3.81), Crohn’s disease (RR of 3.07), RA (RR of 3.06), psoriasis (RR of 2.36), AS (RR of 2.25) and vasculitis (RR of 1.89). The same pattern was applicable when looking at CVD-related mortality.
These findings indicate there was an increased risk of cardiometabolic events within specific chronic inflammatory disorders, even after adjusting for socioeconomic factors.
The authors noted that as the magnitude of the association is very high between specific diseases and cardiometabolic events, particularly for those on NSAIDs and corticosteroids, there needs to be a furtherance of clinical recommendations for early screening and regular monitoring of cardiac health in these patients.