Patients with Chronic Inflammatory Disorders at Greater Risk for Heart Disease, Diabetes, Study Finds

Patients with chronic inflammatory disorders, including ankylosing spondylitis, are at a higher risk of experiencing multiple cardiometabolic events than matching controls with no inflammatory disease.

The risk was almost three times higher for those treated with non-steroidal anti-inflammatory drugs (NSAIDs) compared with those without an inflammatory disease, leading researchers to urge for a closer follow-up of these patients.

The British study reporting the findings is titled, “Cardiovascular and type 2 diabetes morbidity and all-cause mortality among diverse chronic inflammatory disorders,” and was published in the journal Heart.

The underlying mechanism causing ankylosing spondylitis is believed to be autoimmune or autoinflammatory. The disease has no cure, but treatments such as medication, exercise, and surgery may improve symptoms. Medications include NSAIDs, steroids, disease-modifying antirheumatic drugs (DMARDs), and biologic agents.

A total of 19,082 participants with a prior diagnosis of chronic inflammatory disorder were identified from the U.K.’s BioBank database, which holds health information from volunteers for the purposes of research.

The most common inflammatory disorders were psoriasis (31%) and rheumatoid arthritis (28%), followed by Crohn’s disease (13%), ulcerative colitis (7%), ankylosing spondylitis (7%), vasculitis (7%), and systemic lupus erythematosus (3%). The age when diagnosed with an inflammatory disease averaged between 33 (psoriasis) and 57 (vasculitis).

Systemic lupus erythematosus showed the strongest association with cardiometabolic diseases, with a relative risk of 6.36 compared with individuals without inflammatory diseases. The relative risk for cardiometabolic diseases among ankylosing spondylitis patients was 1.28. For psoriasis patients, it was 1.25.

The overall risk of developing multiple cardiometabolic diseases (two or more diseases) was almost three times greater among participants prescribed NSAIDs than among the controls. (That risk was 12.35 for systemic lupus erythematosus patients and 2.25 for ankylosing spondylitis.)

Also, among participants with inflammatory conditions, a 52% overall increased risk of all-cause mortality was observed.

The most common combinations of cardiometabolic disorders were coronary heart disease (CHD) with type 2 diabetes, CHD with venous thromboembolism, and CHD with stroke. Venous thromboembolism is the formation of a blood clot in a vein.

Relatively high incidences of CHD, type 2 diabetes, and venous thromboembolism were seen in the ankylosing spondylitis group.

“Compared with the general population, adults diagnosed with clinically diverse inflammatory disorders present heightened rates of multiple cardiometabolic diseases. This risk varied with anti-inflammatory therapy and time of duration of the disorder,” the team wrote.

“For some inflammatory disorders, the increased risk was detectable early in the course of disorder, supporting the public health value of early screening and effective intervention strategy,” researchers concluded.