1. An increased incidence of new cardiovascular disease was seen in individuals with autoimmune disease compared to those without.

2. This increased risk was greatest in younger patients and increased among patients with multiple autoimmune conditions.

Evidence Rating Level: 2 (Good)

Study Rundown: Autoimmune diseases are known to be associated with cardiovascular disease. This large longitudinal study aimed to evaluate the association between common autoimmune disease and cardiovascular outcomes. Using electronic health records, the study identified individuals with incident autoimmune conditions within a 17-year period. For each included individual, the study identified multiple matched comparison patients. After a median follow-up period of 6.2 years, cardiovascular disease developed in 15.5% of individuals in the autoimmune cohort compared to 11.0% of individuals in the comparison cohort. The risk of cardiovascular disease increased with the number of autoimmune conditions an individual was diagnosed with. The risk was additionally higher in younger patients and those with specific autoimmune conditions, such as systemic sclerosis or Addison’s disease. Limitations of this study include the inability to control for important confounding variables such as patient medications or pre-existing risk of cardiovascular disease, including family history. Nevertheless, this study identified important populations for preventive health planning, such as younger patients with autoimmune disease.

Click to read the study in the Lancet

Relevant Reading: Rheumatoid Arthritis and Incidence of Twelve Initial Presentations of Cardiovascular Disease: A Population Record-Linkage Cohort Study in England

In-Depth [prospective cohort]: This study assembled a cohort of individuals from an electronic health database who were registered between January 1, 2000, to June 30, 2019. From this general population cohort, the study further identified patients with an incident autoimmune disease (from a list of 19 conditions) between January 1, 2000, to December 31, 2017. Eligible participants were younger than 80 years at diagnosis and must have been free of cardiovascular disease until 12 months after the incident autoimmune disease. To avoid including patients with prior autoimmune disease, patients were excluded if they had autoimmune diagnoses prior to January 1, 2000, or within the first 12 months of registration. A randomly selected comparison group was created with individuals matched on age, calendar time, sex, socioeconomic status, and region. The primary endpoint was the presentation of cardiovascular disease (from a list of 12 conditions). A total of 446 449 patients were included in the autoimmune disease cohort with a mean age at diagnosis of 46.2 years and 60.8% being women. There were 2 102 830 individuals in the matched cohort. Incident cardiovascular disease developed in 68 413 (15.5%) of individuals in the autoimmune cohort compared to 231 410 (11.0%) in the comparison group during a median follow-up period of 6.2 years. The incidence rate for cardiovascular disease was greater in patients with autoimmune disease compared to those without (HR 1.56 [95% CI 1.52-1.59]). The risk of cardiovascular disease additionally increased with an increasing number of autoimmune conditions (one disease: HR 1.41; two diseases: 2.63; three or more diseases: 3.79). The risk was higher in younger patients and with specific conditions such as systemic sclerosis, Addison’s disease, systemic lupus erythematosus, and type 1 diabetes.

Image: PD

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