Previous studies have revealed that inflammatory arthritis is associated with an excessive risk of cardiovascular mortality and morbidity. Both traditional cardiovascular risk factors (e.g., hypertension, dyslipidemia, smoking and obesity), and nontraditional cardiovascular risk factors (e.g., inflammation, the use of pharmacological agents such as the nonsteroidal anti-inflammatory drugs and glucocorticoids, and genetic factors) contribute to the increased risk of CVD. 

A new study, conducted by Heslinga et al and published in a recent issue of Rheumatology, analyzed the prevalence proportion and frequency rate of cardiovascular morbidity in patients with inflammatory arthritis compared with controls to ascertain if the coexistence of numerous autoimmune disorders is associated with a heightened CVD risk. The researchers stated that an increased CVD risk with inflammatory arthritis has been demonstrated by many studies; however, it is still undetermined whether other autoimmune disorders are more frequent in inflammatory arthritis patients and how this affects CVD risk. 

The study included data on patients with inflammatory arthritis only, patients with inflammatory arthritis and another comorbid autoimmune disorder, and controls. Data were obtained from the Nivel Primary Care Database. Researchers used Cox regression models to determine hazard ratios (HRs) for the risk for CVD. At the end of the study, researchers identified 28,345 inflammatory arthritis cases and 28,249 matched controls. Two-thirds of the patients were female, and the mean age was 60 years. Among 28,345 patients with inflammatory arthritis, 13.5% had at least one concomitant autoimmune disorder compared with 7.3% of the 28,249 matched controls.

• Results indicated that compared with controls, patients with inflammatory arthritis had both higher prevalence (odds ratio [OR], 1.34; 95% CI, 1.28-1.41) and incidence rates (incidence rate ratio, 1.3; 95% CI, 1.23-1.41). Compared with patients with inflammatory arthritis alone (HR, 1.32; 95% CI, 1.23-1.41), patients with a second comorbid autoimmune disease had an even higher risk for CVD, with an HR of 1.49 (95% CI, 1.31-1.68).
• Compared with controls, patients with inflammatory arthritis had higher rates of other conditions, including type 1 diabetes (OR, 1.80; 95% CI, 1.27-2.55), hypothyroidism (OR, 1.49; 95% CI, 1.37-1.61), psoriasis (OR, 2.72; 95% CI, 2.49-2.97), and inflammatory bowel disease (OR, 2.64; 95% CI, 2.28-3.07).

The researchers concluded that due to the heightened risk of a second autoimmune disorder in inflammatory arthritis patients, physicians should monitor for signs or symptoms of those diseases. Second, the increased CVD risk in inflammatory arthritis patients with multiple autoimmune disorders warrants awareness of this phenomenon. Since autoimmune disorders often coexist, the need for cardiovascular risk management not only in rheumatoid arthritis, but in all inflammatory arthritis patients (especially those with a co-occurring autoimmune disorder), is once again highlighted.

« Click here to return to Cardiology Update.