Abstract Introduction Individuals with autoimmune diseases are at increased risk of developing cardiovascular events later in life. The extent to which known cardiovascular risk factors contribute to this association remains incompletely understood. Methods We used data from the UK Biobank and linked secondary care records to assemble a cohort of individuals free of cardiovascular disease at enrolment. Information on 19 different autoimmune diseases and known cardiovascular risk factors at the time of enrolment was extracted. Missing values in cardiovascular risk factors were imputed using stochastic regression imputation. The incidence of 12 cardiovascular outcomes during follow-up (up until 31/10/2022) was recorded, and Cox-proportional hazards models were used to examine differences in patients with and without autoimmune disease. We report both crude and adjusted estimates, accounting for age, sex, socioeconomic status, smoking history, body mass index, systolic blood pressure, antihypertensive medication use, total and high-density lipoprotein cholesterol, and type 2 diabetes. Results Among 455,050 participants included in the study (mean age, 56.1 standard deviation, 8.1 years; female: n=254,829 56.0%), 19,092 (4.2%) had at least one autoimmune disease diagnosis at baseline. A total of 85,874 (18.9%) individuals experienced at least one cardiovascular outcome over a mean follow-up of 12.5 (standard deviation, 3.0) years. The presence of at least one autoimmune disease was associated with a 74% higher risk of cardiovascular events during follow-up (unadjusted hazard ratio HR, 1.74 95% confidence interval [CI, 1.70-1.79). The greatest relative risks were observed for peripheral artery disease, heart failure, and inflammatory heart diseases (Figure 1). Known cardiovascular risk factors only partly explained observed associations, and an autoimmune disease diagnosis was independently associated with approximately 50% higher risk of cardiovascular events after accounting for a comprehensive set of patient characteristics (multivariable-adjusted HR, 1.46 95% CI, 1.42-1.50). Risk factors, including age, male sex, smoking or body mass index, generally presented similar yet more modest associations with cardiovascular outcomes among individuals with autoimmune diseases compared to those without. Notably, total and high-density lipoprotein cholesterol demonstrated no association with cardiovascular risk in patients with autoimmune disease (Figure 2). Restricting risk factor analyses to atherosclerotic events (ischaemic heart disease, peripheral artery disease and stroke), for which the role of cholesterol is well established, revealed similar patterns. Conclusions Individuals with autoimmune diseases are at significantly higher risk of developing a broad range of cardiovascular outcomes, independent of factors routinely considered in cardiovascular risk screening.
Schuermans et al. (Sat,) studied this question.
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