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Increased short-term risk of cardiovascular events in inflammatory rheumatic diseases: results from a population-based cohort

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Abstract

Cardiovascular diseases represent the first cause of death globally. Inflammatory rheumatic disease (IRMD) patients, due to their lifelong inflammatory status, are at increased risk of developing premature cardiovascular disease. We aimed to assess the risk for cardiovascular events (CVE) in a population-based study. We followed 10,153 adults from the EpiDoC Cohort, a large Portuguese population-based prospective study (2011–2016). IRMD patients were identified at baseline and followed during 5 years. CVE were defined as a composite of self-reported myocardial infarction or angina pectoris, arrhythmias, valvular disease, stroke or transient ischemic attack and peripheral artery disease. Statistical analysis was performed by utilizing multivariate logistic regression and goodness-of-fit and area under ROC curve. At baseline, IRMD patients had similar age as the non-IRMD participants (mean age 55 vs 53 years-old; 72.1% female); dyslipidaemia and sedentary lifestyle were more common (40.7% vs 31.4%, p = 0.033; 87.3% vs 67%, p = 0.016, respectively). During an average follow-up of 2.6 years, 26 CVE were reported among IRMD patients. IRMD patients had higher odd of CVE (OR 1.64, 95% CI 1.04–2.58; p = 0.03), despite comparable mortality rates (1.7% vs 0.7%, p = 0.806). A stepwise approach attained that gender, age, history of hypertension, body mass index, IRMD and follow-up time are the most important predictive variables of CVE (AUC 0.80). IRMD patients, at community level, have an increased short-term risk of major CVE when compared to non-IRMD, and that highlights the potential benefit of a systematic screening and more aggressive cardiovascular risk assessment and management of these patients.

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Funding

The projects that contributed to this database were supported by a grant for clinical research from the Portuguese Society of Rheumatology and a grant from Portuguese Society of Rheumatology/ Pfizer 2017. The funders took no involvement with the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have no potential conflicts of interest.

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Authors and Affiliations

  1. Centro Hospitalar do Porto, Porto, Portugal

    Vital Da Silva Domingues

  2. Instituto Gulbenkian de Ciência, Oeiras, Portugal

    Vital Da Silva Domingues

  3. Centro de Estudos de Doenças Crónicas (CEDOC), EpiDoc Unit, Unidade de Epidemiologia em Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Lisboa, Portugal

    Vital Da Silva Domingues, Ana M. Rodrigues, Sara S. Dias, Jaime Branco & Helena Canhão

  4. Comprehensive Health Research Centre, Lisbon, Portugal

    Vital Da Silva Domingues, Ana M. Rodrigues, Sara S. Dias, Jaime Branco & Helena Canhão

  5. Center for Innovative Care and Health Technology (CiTechCare), School of Health Sciences, Polytechnic Institute of Leiria, Leiria, Portugal

    Sara S. Dias

  6. Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal

    Luís Delgado

  7. Centro Hospitalar São João, Porto, Portugal

    Luís Delgado

  8. Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Ebrahim Barkoudah

  9. Serviço de Reumatologia do Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental (CHLO-EPE), Lisboa, Portugal

    Jaime Branco

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  1. Vital Da Silva Domingues
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  2. Ana M. Rodrigues
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by VSD, AMR and SSD. The first draft of the manuscript was written by VSD and all authors commented on previous versions of the manuscript. All authors read, approved and take full responsibility for the integrity of the study and the final manuscript.

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Correspondence to Vital Da Silva Domingues.

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Conflict of interest

Dr. Barkoudah reports research support from National Institutes of Health/National Heart, Lung, and Blood Institute, Bristol Myers Squibb and Janssen, payments made to Brigham and Women’s Hospital for performing clinical endpoints and Advisory Board fees from Bristol Myers Squibb, Janssen, Novartis, Pfizer and Portola, and travel expenses from Alexion; all outside he presented work. No other conflict of interest was identified.

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Approved by NOVA Medical School Ethics Committee and the National Committee for Data Protection.

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Da Silva Domingues, V., Rodrigues, A.M., Dias, S.S. et al. Increased short-term risk of cardiovascular events in inflammatory rheumatic diseases: results from a population-based cohort. Rheumatol Int 41, 311–318 (2021). https://doi.org/10.1007/s00296-020-04754-7

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