Differential Associations of Chronic Inflammatory Diseases With Incident Heart Failure

Abstract

Objectives: The purpose of this study was to compare the risks of incident heart failure (HF) among a variety of chronic inflammatory diseases (CIDs) and to determine whether risks varied by severity of inflammation within each CID.

Background: Individuals with CIDs are at elevated risk for cardiovascular diseases, but data are limited regarding risk for HF.

Methods: An electronic health records database from a large urban medical system was examined, comparing individuals with CIDs with frequency-matched controls without CIDs, all of whom were receiving regular outpatient care. Rates of incident HF were determined by using the Kaplan-Meier method and subsequently used multivariate-adjusted proportional hazards models to compare HF risks for each CID. Exploratory analyses determined HF risks by proxy measurement of CID severity.

Results: Of 37,636 patients (n = 18,278 patients with CIDs; and n = 19,358 controls without CIDs) there were 960 incident HF cases over a median of 3.6 years. Risks for incident HF were significantly or borderline significantly elevated for patients with systemic sclerosis (hazard ratio [HR]: 7.26; 95% confidence interval [CI]: 5.72 to 9.21; p < 0.01), systemic lupus erythematosus (HR: 3.15; 95% CI: 2.41 to 4.11; p < 0.01), rheumatoid arthritis (HR: 1.39; 95% CI: 1.13 to 1.71; p < 0.01), and human immunodeficiency virus (HR: 1.28; 95% CI: 0.99 to 1.66; p = 0.06). There was no association between psoriasis or inflammatory bowel disease and incident HF, although patients with those CIDs with higher levels of C-reactive protein had higher risks for HF than controls.

Conclusions: Systemic sclerosis and systemic lupus erythematosus were associated with the highest risks of HF, followed by rheumatoid arthritis and HIV. Measurements of inflammation were associated with HF risk across different CIDs.

Keywords: autoimmune disorders; chronic inflammatory diseases; electronic cohort; heart failure; inflammation.

Figure 1.. Cohort creation flow diagram

Persons with chronic inflammatory diseases and controls matched 1:1 based on demographics, baseline year, hypertension, and diabetes were analyzed after excluding persons with baseline heart failure and those with missing baseline co-variates. HF = Heart Failure; HIV = human immunodeficiency virus; IBD = inflammatory bowel disease; Pso = psoriasis; RA = rheumatoid arthritis; SSc = systemic sclerosis; SLE = systemic lupus erythematosus.

Figure 2.. Heart failure cumulative incidence among chronic inflammatory disease groups

Kaplan-Meier cumulative incidence curves for incident heart failure by chronic inflammatory disease group over median follow-up period of 3.6 years. Curves presented for demographic subsets. CID = chronic inflammatory disease; other abbreviations as in Figure 1.

Figure 3.. Heart failure risk among chronic inflammatory disease (CID) groups stratified by severity of CID

Adjusted cox proportional hazard ratios (square markers) and 95% confidence intervals (error bars) for incident heart failure (HF) for each CID group stratified by CID severity presented in a forest plot. CID severity defined by tertile of peak C-reactive protein level (and nadir CD4 for HIV). Adjusted for age, sex, race, insurance, hypertension, diabetes, and chronic kidney disease (Model 2). Abbreviations as in Figure 1. N for control = 19,358

Central Illustration.. Heart failure risk among chronic inflammatory disease groups

Adjusted cox proportional hazard ratios (square markers) and 95% confidence intervals (error bars) for incident heart failure for each chronic inflammatory disease group are presented in forest plots after adjustment for (A) age, sex, race, insurance, hypertension, diabetes (Model 1) and (B) additional adjustment for chronic kidney disease (Model 2). CID = chronic inflammatory disease; other abbreviations as in Figure 1.

Central Illustration.. Heart failure risk among chronic inflammatory disease groups

Adjusted cox proportional hazard ratios (square markers) and 95% confidence intervals (error bars) for incident heart failure for each chronic inflammatory disease group are presented in forest plots after adjustment for (A) age, sex, race, insurance, hypertension, diabetes (Model 1) and (B) additional adjustment for chronic kidney disease (Model 2). CID = chronic inflammatory disease; other abbreviations as in Figure 1.