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. 2022 Jul 7;12(1):11548.
doi: 10.1038/s41598-022-15436-8.

Effects of immune-mediated inflammatory diseases on cardiovascular diseases in patients with type 2 diabetes: a nationwide population-based study

Oh Chan Kwon  1 , Kyungdo Han  2 , Jaeyoung Chun  3 , Ryul Kim  4 , Seung Wook Hong  5 , Jie-Hyun Kim  6 , Young Hoon Youn  6 , Hyojin Park  6 , Min-Chan Park  1 ; Gastroenterology, Neurology and Rheumatology National Data Science Research (GUARANTEE) Group
Collaborators, Affiliations

Effects of immune-mediated inflammatory diseases on cardiovascular diseases in patients with type 2 diabetes: a nationwide population-based study

Oh Chan Kwon et al. Sci Rep. .

Abstract

Both type 2 diabetes and immune-mediated inflammatory diseases (IMIDs), such as Crohn's disease (CD), ulcerative colitis, rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriasis (PsO) are risk factors of cardiovascular disease. Whether presence of IMIDs in patients with type 2 diabetes increases their cardiovascular risk remains unclear. We aimed to investigate the risk of cardiovascular morbidity and mortality in patients with type 2 diabetes and IMIDs. Patients with type 2 diabetes without cardiovascular disease were retrospectively enrolled from nationwide data provided by the Korean National Health Insurance Service. The primary outcome was cardiovascular mortality, and the secondary outcomes were myocardial infarction (MI), stroke, and all-cause mortality. Inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression analysis was performed to estimate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for each IMID. Overall 2,263,853 patients with type 2 diabetes were analyzed. CD was associated with a significantly higher risk of stroke (IPTW-adjusted HR: 1.877 [95%CI 1.046, 3.367]). UC was associated with a significantly higher risk of MI (1.462 [1.051, 2.032]). RA was associated with a significantly higher risk of cardiovascular mortality (2.156 [1.769, 2.627]), MI (1.958 [1.683, 2.278]), stroke (1.605 [1.396, 1.845]), and all-cause mortality (2.013 [1.849, 2.192]). AS was associated with a significantly higher risk of MI (1.624 [1.164, 2.266]), stroke (2.266 [1.782, 2.882]), and all-cause mortality (1.344 [1.089, 1.658]). PsO was associated with a significantly higher risk of MI (1.146 [1.055, 1.246]), stroke (1.123 [1.046, 1.205]) and all-cause mortality (1.115 [1.062, 1.171]). In patients with type 2 diabetes, concomitant IMIDs increase the risk of cardiovascular morbidity and mortality. Vigilant surveillance for cardiovascular disease is needed in patients with type 2 diabetes and IMIDs.

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Conflict of interest statement

Dr. Chun received a grant given by Eisai Co. All other authors disclose that they have no financial, professional, or personal conflicts related to this publication.

Figures

Figure 1
Figure 1
Flowchart depicting inclusion of patients. NHIS, National Health Insurance Service; MI, myocardial infarction.
Figure 2
Figure 2
Comparison of cumulative incidence of (A) cardiovascular mortality, (B) MI, (C), stroke, and (D) all-cause mortality according to the presence of each IMID. CD, crohn’s disease; UC, ulcerative colitis; RA, rheumatoid arthritis; AS, ankylosing spondylitis; PsO, psoriasis; MI, myocardial infarction; IMIDs, immune-mediated inflammatory disease.
Figure 3
Figure 3
A forest plot showing IPTW-adjusted HRs and 95% CIs for (A) cardiovascular mortality, (B) MI, (C), stroke, and (D) all-cause mortality. IPTW, inverse probability of treatment weighting; HR, hazard ratio; CI, confidence interval; CD, Crohn’s disease; UC, ulcerative colitis; RA, rheumatoid arthritis; AS, ankylosing spondylitis; PsO, psoriasis; MI, myocardial infarction.
Figure 4
Figure 4
Summary of the present nationwide population-based study. CD, crohn’s disease; UC, ulcerative colitis; RA, rheumatoid arthritis; AS, ankylosing spondylitis; PsO, psoriasis; HR, hazard ratio.
See this image and copyright information in PMC

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