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Chronic Inflammatory Disorders and Risk of Type 2 Diabetes Mellitus, Coronary Heart Disease, and Stroke: A Population-Based Cohort Study
Study Questions:
Do chronic inflammatory diseases increase the risk for type 2 diabetes mellitus (T2DM), coronary heart disease (CHD), and stroke?
Methods:
This was a matched cohort study including participants with severe psoriasis (5,648), mild psoriasis (85,232), bullous skin diseases (4,284), ulcerative colitis (12,203), Crohn’s disease (7,628), inflammatory arthritis (27,358), systemic autoimmune disorders (7,472), systemic vasculitis (6,283), and 373,851 matched controls. Main outcome measures were new diagnoses of T2DM, stroke, or CHD.
Results:
There were 4,695 T2DM, 3,266 CHD, and 1,715 stroke diagnoses. The pooled hazard ratio (HR) was 1.20 (95% confidence interval [CI], 1.15-1.26). The highest HRs were observed in systemic autoimmune disorders (1.32) and systemic vasculitis (1.29). HRs were increased in organ-specific disorders, including severe psoriasis (1.29) and ulcerative colitis (1.26). Subjects in the highest tertile of C-reactive protein had greater risk of multiple outcomes (HR, 1.52).
Conclusions:
The risk of cardiovascular disease and T2DM is increased across a range of organ-specific and multi-system chronic inflammatory disorders with evidence that risk is associated with severity of inflammation.
Perspective:
Atherosclerosis is an inflammatory disease and previous studies have demonstrated that the risk for cardiovascular disease complications is elevated in patients with a variety of other diseases associated with inflammation. This current cohort study, using data from the world’s largest primary care electronic database (UK Clinical Practice Research Datalink), confirms that this relationship is relevant across a broad range of inflammatory diseases. Uncovering the underlying mechanisms for these relationships may identify new therapeutic targets, but the immediate practical implication of these findings, as the authors point out, is that management of patients with these inflammatory diseases should include measures to reduce cardiovascular risk.
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