Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-ro, Dongjak-gu, Seoul, 06978, Korea.
Sci Rep. 2022 Jul 7;12(1):11548. doi: 10.1038/s41598-022-15436-8.
Both type 2 diabetes and immune-mediated inflammatory diseases (IMIDs), such as Crohn's disease (CD), ulcerative colitis, rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriasis (PsO) are risk factors of cardiovascular disease. Whether presence of IMIDs in patients with type 2 diabetes increases their cardiovascular risk remains unclear. We aimed to investigate the risk of cardiovascular morbidity and mortality in patients with type 2 diabetes and IMIDs. Patients with type 2 diabetes without cardiovascular disease were retrospectively enrolled from nationwide data provided by the Korean National Health Insurance Service. The primary outcome was cardiovascular mortality, and the secondary outcomes were myocardial infarction (MI), stroke, and all-cause mortality. Inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression analysis was performed to estimate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for each IMID. Overall 2,263,853 patients with type 2 diabetes were analyzed. CD was associated with a significantly higher risk of stroke (IPTW-adjusted HR: 1.877 [95%CI 1.046, 3.367]). UC was associated with a significantly higher risk of MI (1.462 [1.051, 2.032]). RA was associated with a significantly higher risk of cardiovascular mortality (2.156 [1.769, 2.627]), MI (1.958 [1.683, 2.278]), stroke (1.605 [1.396, 1.845]), and all-cause mortality (2.013 [1.849, 2.192]). AS was associated with a significantly higher risk of MI (1.624 [1.164, 2.266]), stroke (2.266 [1.782, 2.882]), and all-cause mortality (1.344 [1.089, 1.658]). PsO was associated with a significantly higher risk of MI (1.146 [1.055, 1.246]), stroke (1.123 [1.046, 1.205]) and all-cause mortality (1.115 [1.062, 1.171]). In patients with type 2 diabetes, concomitant IMIDs increase the risk of cardiovascular morbidity and mortality. Vigilant surveillance for cardiovascular disease is needed in patients with type 2 diabetes and IMIDs.
2 型糖尿病和免疫介导的炎症性疾病（IMIDs），如克罗恩病（CD）、溃疡性结肠炎、类风湿关节炎（RA）、强直性脊柱炎（AS）和银屑病（PsO），都是心血管疾病的危险因素。在 2 型糖尿病患者中，IMIDs 的存在是否会增加其心血管风险尚不清楚。我们旨在研究 2 型糖尿病合并 IMIDs 患者的心血管发病率和死亡率。从韩国国家健康保险服务提供的全国性数据中，回顾性招募了无心血管疾病的 2 型糖尿病患者。主要结局为心血管死亡率，次要结局为心肌梗死（MI）、卒中和全因死亡率。采用逆概率治疗加权（IPTW）调整的 Cox 比例风险回归分析来估计每种 IMID 的风险比（HR）和 95%置信区间（95%CI）。共分析了 2263853 例 2 型糖尿病患者。CD 与卒中风险显著升高相关（IPTW 调整的 HR：1.877 [95%CI 1.046，3.367]）。UC 与 MI 风险显著升高相关（1.462 [1.051，2.032]）。RA 与心血管死亡率（2.156 [1.769，2.627]）、MI（1.958 [1.683，2.278]）、卒中和全因死亡率（2.013 [1.849，2.192]）显著升高相关。AS 与 MI（1.624 [1.164，2.266]）、卒中和全因死亡率（2.266 [1.782，2.882]）显著升高相关。PsO 与 MI（1.146 [1.055，1.246]）、卒中和全因死亡率（1.123 [1.046，1.205]）显著升高相关。在 2 型糖尿病患者中，合并 IMIDs 会增加心血管发病率和死亡率的风险。需要对 2 型糖尿病合并 IMIDs 患者进行心血管疾病的密切监测。
