Dregan Alex, Chowienczyk Phil, Molokhia Mariam
Department of Primary Care and Public Health Sciences, King's College London, London, UK.
National Institute for Health Research Biomedical Research Centre, Guy's and St Thomas NHS Foundation Trust, London, UK.
Heart. 2017 Dec;103(23):1867-1873. doi: 10.1136/heartjnl-2017-311214. Epub 2017 Jun 10.
The present study aimed to assess the relationship between inflammatory disorders with cardiometabolic diseases and mortality within a community-based population.
The UK Biobank data were used to conduct two investigations: a cross-sectional study to estimate cardiometabolic risk and a prospective cohort study to estimate mortality risk. Binary regression analyses were used to model the association between coronary heart disease, stroke, type 2 diabetes, venous thromboembolism and peripheral artery disease diagnoses with seven inflammatory disorders (eg, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriasis, ankylosing spondylitis (AS), systemic vasculitis, Crohn's disease and ulcerative colitis (UC)). Cox proportional hazards was used to estimate all-cause and cardiovascular-related mortality.
About 4% (n=19, 082) of the study population (n=5 02 641) were diagnosed with a chronic inflammatory disorder. The most common inflammatory disorder was psoriasis (n=6286), and the least common was SLE (n=654). SLE showed the strongest association with multiple (relative risk (RR) 6.36, 95% CI 4.37 to 9.25) risk of cardiometabolic diseases, followed by the RA (RR 1.70, 95% CI 1.59 to 1.83), UC (RR 1.69, 95% CI 1.51 to 1.89), AS (RR 1.28, 95% CI 1.09 to 1.52), vasculitis (RR 1.64, 95% CI 1.42-1.90) and psoriasis (RR 1.25, 95% 1.16 to 1.35) disorders. The magnitude of the association was higher among participants prescribed non-steroidal anti-inflammatory drugs or corticosteroids drugs, with multiple cardiometabolic risk being greater within SLE (RR 12.35, 95% CI 7.18 to 21.24), followed by UC (RR 3.81, 95% CI 2.69 to 5.38), Crohn's disease (RR 3.07, 95% CI 1.85 to 5.11), RA (RR 3.06, 95% CI 2.44 to 3.85), psoriasis (RR 2.36, 95% CI 1.88 to 2.95), AS (RR 2.25, 95% CI 1.48 to 3.41) and vasculitis (RR 1.89, 95% CI 1.28 to 2.79). Similar pattern was observed with respect to the cumulative cardiometabolic risk.
Inflammatory disorders are associated with heightened risk of cardiometabolic events, which may vary by anti-inflammatory therapy and duration. All-cause mortality was also higher among specific inflammatory disorders compared with the absence of inflammatory disorders.
本研究旨在评估社区人群中炎症性疾病与心脏代谢疾病及死亡率之间的关系。
利用英国生物银行数据进行两项调查：一项横断面研究以估计心脏代谢风险，一项前瞻性队列研究以估计死亡风险。采用二元回归分析对冠心病、中风、2型糖尿病、静脉血栓栓塞和外周动脉疾病诊断与七种炎症性疾病（如类风湿性关节炎（RA）、系统性红斑狼疮（SLE）、银屑病、强直性脊柱炎（AS）、系统性血管炎、克罗恩病和溃疡性结肠炎（UC））之间的关联进行建模。使用Cox比例风险模型估计全因死亡率和心血管相关死亡率。
在研究人群（n = 502641）中，约4%（n = 19082）被诊断患有慢性炎症性疾病。最常见的炎症性疾病是银屑病（n = 6286），最不常见的是SLE（n = 654）。SLE与多种心脏代谢疾病风险的关联最强（相对风险（RR）6.36，95%置信区间4.37至9.25），其次是RA（RR 1.70，95%置信区间1.59至1.83）、UC（RR 1.69，95%置信区间1.51至1.89）、AS（RR 1.28，95%置信区间1.09至1.52）、血管炎（RR 1.64，95%置信区间1.42 - 1.90）和银屑病（RR 1.25，95% 1.16至1.35）疾病。在使用非甾体抗炎药或皮质类固醇药物治疗的参与者中，关联程度更高，SLE中多种心脏代谢风险更大（RR 12.35，95%置信区间7.18至21.24），其次是UC（RR 3.81，95%置信区间2.69至5.38）、克罗恩病（RR 3.07，95%置信区间1.85至5.11）、RA（RR 3.06，95%置信区间2.44至3.85）、银屑病（RR 2.36，95%置信区间1.88至2.95）、AS（RR 2.25，95%置信区间1.48至3.41）和血管炎（RR 1.89，95%置信区间1.28至2.79）。在累积心脏代谢风险方面也观察到类似模式。
炎症性疾病与心脏代谢事件风险升高相关，这可能因抗炎治疗和持续时间而异。与无炎症性疾病相比，特定炎症性疾病中的全因死亡率也更高。
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