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.

Keywords: HIV–human immunodeficiency virus; coronary heart disease; inflammation; lupus (SLE); psoriasis; rheumatoid arthritis; systemic sclerosis.

Figure 1

Chronic inflammatory disease cohort creation flow diagram. CHD, coronary heart disease; CID, chronic inflammatory disease; HIV, human immunodeficiency virus; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; SSc, systemic sclerosis; IBD, inflammatory bowel disease.

Figure 2

Risk of incident coronary heart disease and myocardial infarction among chronic inflammatory disease groups. Analysis performed in nested cohort. Cox proportional hazard ratios adjusted for age, sex, race/ethnicity, insurance, baseline year, hypertension, diabetes, current smoking, total cholesterol, statin use, and systemic steroid use. CHD, coronary heart disease; MI, myocardial infarction; HR, hazard ratio; CID, chronic inflammatory disease; HIV, human immunodeficiency virus; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; SSc, systemic sclerosis; IBD, inflammatory bowel disease.

Figure 3

Risk of incident coronary heart disease among chronic inflammatory disease groups stratified by disease severity. Analysis performed in nested cohort. Cox proportional hazard ratios adjusted for age, sex, race/ethnicity, insurance, baseline year, hypertension, diabetes, current smoking, total cholesterol, statin use, and systemic steroid use. CHD, coronary heart disease; HR, hazard ratio; CID, chronic inflammatory disease; HIV, human immunodeficiency virus; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; SSc, systemic sclerosis; IBD, inflammatory bowel disease.

Figure 4

Risk of incident myocardial infarction among chronic inflammatory disease groups stratified by disease severity. Analysis performed in nested cohort. Cox proportional hazard ratios adjusted for age, sex, race/ethnicity, insurance, baseline year, hypertension, diabetes, current smoking, statin use, and systemic steroid use. MI, myocardial infarction; HR, hazard ratio; CID, chronic inflammatory disease; HIV, human immunodeficiency virus; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; SSc, systemic sclerosis; IBD, inflammatory bowel disease.