Acute Coronary Syndrome in Idiopathic Inflammatory Myopathies: A Population-based Study

Abstract

Objective.Evidence suggests an increased risk of cardiovascular (CV) diseases, including acute coronary syndrome (ACS), in idiopathic inflammatory myopathies (IIM). The aim of this study was to investigate the risk of ACS in an incident IIM cohort compared to the general Swedish population.Methods.A cohort of 655 individuals with incident IIM and 6813 general population comparators were identified from national registries. IIM subjects were diagnosed from 2002 to 2011. Followup started at IIM diagnosis and corresponding date in the general population. ACS, CV comorbidities, and CV risk factors were defined using International Classification of Diseases codes. Incidence rates including 95% CI were calculated. Cox proportional hazards models were used to compare the risk of ACS in patients with IIM and the general population. The competing risk of death was accounted for using competing risk regression models.Results.The incidence rate of ACS in IIM was higher than in the general population, particularly within the first year of diagnosis and in older individuals. The overall ACS incidence rate in IIM was 15.6 (95% CI 11.7–20.4) per 1000 person-years, with an HR of 2.4 (95% CI 1.8–3.2) compared with the general population. When accounting for the competing risk of death, the risk of ACS in IIM remained increased with a cumulative incidence of 7% at 5 years compared to 3.3% in the general population.Conclusion.IIM individuals are at higher risk of ACS, particularly within the first year after diagnosis.

Coronary Heart Disease and Cardiovascular Risk Factors in Patients With Idiopathic Inflammatory Myopathies: A Systemic Review and Meta-Analysis

“…For example, the study by Antovic et al (26) and the study by Moshtaghi-Svensson et al (27) used the same databases (the Swedish National Patient Register Database and the Swedish Population Register Database), but the latter reported the most comprehensive results, thus, we only included the study by Moshtaghi-Svensson et al in the current review. Finally, seven articles focused on CHD risk and nine articles focused on cardiovascular risk factors met the inclusion criteria and were included in this meta-analysis (11)(12)(13)(14)(15)(16)(17)(27)(28)(29)(30)(31)(32)(33)(34). Moreover, the majority of eligible studies in the current review were about patients with DM/PM, but these studies did not describe the different subtypes of PM or DM in detail.…”

“…Among the studies on the risk of CHD, the number of IIMs patients ranged from 350 to 10,156, with the mean age of IIMs patients ranging from 46.1 to 62.4 years, and the proportion of females in the case group ranged between 45 and 73.2%. Moreover, five of these studies strictly defined CHD as MI or acute coronary syndrome (ACS) (11)(12)(13)(14)16), while the remaining two studies used broader definitions of CHD (15,17). The study by Linos et al (17) defined CHD as AMI, angina, and coronary intervention (coronary artery bypass grafting or percutaneous transluminal coronary angioplasty), but in another study, CHD was defined as AMI, angina and chronic CHD (15).…”

“…It is worth mentioning that multiple studies have exhibited a strict association between connective tissue diseases (CTDs) and CHD risk, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc), but the risk of CHD in IIMs patients is still inconclusive due to the conflicting epidemiological studies (8)(9)(10). Some studies demonstrated an increased risk of CHD among IIMs patients compared with the general population (11)(12)(13)(14)(15)(16), but the study by Linos et al found that there was no significant association between DM and CHD risk (17). So far, there is only one systemic review and metaanalysis to assess the risk of CHD in patients with IIMs, while it contains only four studies and is not enough to draw strong conclusions (18).…”

“…So far, there is only one systemic review and metaanalysis to assess the risk of CHD in patients with IIMs, while it contains only four studies and is not enough to draw strong conclusions (18). Moreover, a number of studies focused on CHD risk among IIMs patients have been published after the study by Ungprasert et al (11)(12)(13)16). Thus, we perform a systemic review and meta-analysis of all published observational studies which compare the risk of CHD between IIMs patients and control subjects.…”

Cardiovascular risk management in patients with immune-mediated inflammatory diseases

“…An increase in atherosclerotic vascular disease detected by coronary CT has been reported 36 as well as an increased risk of MI 37 , ACS 38 , and stroke 37 . These facts are partly explained by the chronic inflammatory process.…”