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Autoimmune disorders increase the risk of cardiovascular disease – The Hippocratic Post

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Autoimmune disorders are associated with a substantially higher risk of developing cardiovascular disease than people without autoimmune diseases, according to a new large epidemiological study.

The research, led by KU Leuven in collaboration with colleagues in the UK including the University of Glasgow, and published today in The Lancet, shows for the first time that cardiovascular risks affect autoimmune disorders as a group of diseases, with implications in a wide range of cardiovascular outcomes.

The excess risk is particularly high among younger patients and suggests that autoimmune disorders are particularly important in causing premature cardiovascular disease, with the potential to result in disproportionate years of life lost and disability.

Around ten percent of the population in high-income regions such as Europe and the United States have been diagnosed with one or more autoimmune disorders. Some examples are rheumatoid arthritis, psoriasis, systemic sclerosis, lupus erythematosus, and type I diabetes.

Although previous research has suggested associations between some of these disorders and increased risk of cardiovascular disease, these studies were often small and limited to selected autoimmune or cardiovascular diseases.

The findings will be announced this weekend at the European Society of Cardiology annual congress in Barcelona, ​​where an international research team led by KU Leuven will present the result of a comprehensive epidemiological investigation into potential links between 19 of the disorders. most common autoimmune and cardiovascular diseases.

The results of the study show that patients with autoimmune disease have a substantially higher risk (between 1.4 and 3.6 times depending on the autoimmune condition) of developing cardiovascular disease than people without an autoimmune disorder.

This excess risk is comparable to that of type 2 diabetes, a known risk factor for cardiovascular disease. The research shows for the first time that cardiovascular risks affect autoimmune diseases as a group of disorders, rather than individually selected disorders.

In The Lancet article, the authors show that the group of nineteen autoimmune disorders they have studied accounts for approximately 6% of cardiovascular events. Importantly, excess cardiovascular risk was visible across the spectrum of cardiovascular disease, beyond classic coronary heart disease, including infection-related heart conditions, heart inflammation, as well as thromboembolic and degenerative heart conditions, which suggests that the implications of autoimmunity on cardiovascular health are likely to be much broader than originally thought.

Furthermore, the excess risk was not explained by traditional cardiovascular risk factors such as age, gender, socioeconomic status, blood pressure, BMIsmoking, cholesterol, and type 2 diabetes. Another noteworthy finding: excess risk is particularly high among patients with autoimmune disorders younger than 55 years and suggests that autoimmune disease is particularly important in causing premature cardiovascular disease, with the potential to result in disproportionate years of life lost and disability.

The study was based on electronic health records from the UK’s Clinical Practice Research Datalink (CPRD), a very large database of anonymous patient data from about a fifth of the current UK population. From 22 million patient records, the researchers assembled a cohort of newly diagnosed patients with any of nineteen autoimmune disorders.

They then looked at the incidence of 12 cardiovascular outcomes, an unprecedented granularity made possible by the large size of the data set, in subsequent years, and compared it to a matched control group.

The risk of developing cardiovascular disease for patients with one or more autoimmune disorders was on average 1.56 times higher than in those without autoimmune disease. They also found that the excess risk increased with the number of different autoimmune disorders in individual patients. Disorders with the highest excess risk include systemic sclerosis, Addison’s disease, lupus, and type I diabetes.

Nathalie Conrad, lead author of the study from KU Leuven, said: “The results show that action is needed. We see that the excess risk is comparable to that of type 2 diabetes. But although we have specific measures aimed at patients with diabetes to reduce their risk of developing cardiovascular diseases, in terms of prevention and monitoring, we do not have similar measures for patients with autoimmune disorders ”.

The European Society of Cardiology guidelines on the prevention of cardiovascular diseases do not currently mention autoimmunity as a cardiovascular risk factor, nor do they list specific prevention measures for patients with autoimmune diseases.

Professor John McMurray, Professor of Cardiology at the University of Glasgow School of Cardiovascular and Metabolic Health, said: “This important population-based study suggests that a much broader range of autoimmune disorders than previously recognized are associated with a variety of different cardiovascular problems.

“Some of these problems are potentially preventable using readily available treatments like statins. The scale of this huge new study and the breadth of the findings across the spectrum of autoimmune diseases suggest that the contribution of these conditions to the burden of cardiovascular disease in the community may be considerable and the value of a preventive approach substantial.”

Professor Conrad added: “We hope that the study will raise awareness among patients with autoimmune diseases and the clinicians involved in the care of these patients, who will include many different specialties such as cardiologists, rheumatologists or general practitioners.

“We need to develop specific prevention measures for these patients. And we need to do more research to help us understand why patients with an autoimmune disorder develop more cardiovascular disease than others, and how we can prevent this from happening.”

The article, ‘Autoimmune disorders and cardiovascular risk: a population-based study of 19 autoimmune disorders and 12 cardiovascular diseases in 22 million people’ is published in The Lancet. The study was funded by the European Union Horizon 2020, the European Society of Cardiology, the Wellcome Trust, the National Institute for Health and Care Research (NIHR), the British Heart Foundation and the UKRI Global Challenge Research Fund.

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