Cardiovascular disease in immune-mediated inflammatory diseases

Fernández‐Gutiérrez, Benjamín; Perrotti, Pedro Pablo; Gisbert, Javier P.; Domènech, Eugeni; Fernández‐Nebro, Antonio; Cañete, Juan D.; Ferrándiz, Carlos; Tornero, Jesús; García–Sánchez, Valle; Panés, Julián; Fonseca, Eduardo; Blanco, Francisco J.; Rodriguez-Moréno, J; Carreira, Patrícia; Juliá, Antonio; Marsal, Sara; Rodríguez‐Rodríguez, Luis

doi:10.1097/md.0000000000007308

Cited by 35 publications

(18 citation statements)

References 35 publications

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“…By contrast, this association is not as clear in SpA, where there are fewer, smaller studies with significant heterogeneity in results (20,29). Several reports have suggested that, when appropriately adjusted for age and gender, the risk of MACEs in PsA and AS may be less than in RA (20,30,31). In fact, in several AS studies, the lower limit of the 95% confidence interval for the risk of IHD was 1.0 or less (20,21,32), whereas others report IHD rates similar to RA (33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of Hypertension Associated with Spondyloarthritis Disease Duration: Results from the ASAS-COMOSPA Study

Derakhshan¹,

Goodson²,

Packham³

et al. 2019

J Rheumatol

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Objective.Spondyloarthritis (SpA) is associated with a number of cardiovascular (CV) comorbidities. We examined the association of SpA disease duration and delay in diagnosis with CV-related conditions.Methods.Using data from the COMOSPA study, the associations between SpA disease duration and CV-related conditions were evaluated in univariable and multivariable logistic regression models. Each model examined 1 CV-related factor as dependent and “SpA disease duration” as a predictor, adjusted for relevant confounders.Results.Data from 3923 subjects (median SpA disease duration 5.1 yrs, interquartile range 1.3–11.8 yrs) were available for analysis. The main CV-related conditions were hypertension (HTN; 22.4%), ischemic heart disease (2.6%), stroke (1.3%), and diabetes mellitus (5.5%). HTN was associated with SpA disease duration in both univariable and multivariable analysis, with an OR of 1.129 (95% CI 1.072–1.189; p < 0.001) for each 5-year increase in SpA disease duration. Other factors associated with HTN were age, male sex, current body mass index, ever steroid therapy, and ever synthetic disease-modifying antirheumatic drug therapy, but not nonsteroidal antiinflammatory drugs (NSAID). In subgroup analysis, the strongest association of HTN and disease duration was seen in subjects with the axial-only SpA phenotype (OR 1.202, 95% CI 1.053–1.372) but not in those with peripheral-only SpA (OR 0.902, 95% CI 0.760–1.070). The other CV conditions were not associated with SpA disease duration.Conclusion.Duration of SpA disease in the ASAS-COMOSPA cohort is associated with higher odds of HTN, particularly in those with axial disease, but not with other CV-related conditions. The association with HTN does not appear to be related to NSAID exposure.

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Section: Discussionmentioning

confidence: 99%

Increased Risk of Hypertension Associated with Spondyloarthritis Disease Duration: Results from the ASAS-COMOSPA Study

Derakhshan¹,

Goodson²,

Packham³

et al. 2019

J Rheumatol

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“…Psoriasis is a chronic inflammatory skin disease associated with increased cardiovascular morbidity and mortality 11, 12. Several mechanisms have been proposed to explain the relationship between psoriasis and cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

Should all patients with psoriasis receive statins? Analysis according to different strategies

Masson

Lobo²,

Molinero³

et al. 2019

Anais Brasileiros de Dermatologia

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BackgroundDifferent strategies have been proposed for the cardiovascular risk management of patients with psoriasis.ObjectiveTo estimate the cardiovascular risk and evaluate two cardiovascular prevention strategies in patients with psoriasis, analyzing which proportion of patients would be candidates to receive statin therapy.MethodsA retrospective cohort was selected from a secondary database. All patients >18 years with psoriasis without cardiovascular disease or lipid-lowering treatment were included. The atherosclerotic cardiovascular disease calculator (2018 American College of Cardiology/American Heart Association guidelines) and the Systematic Coronary Risk Evaluation risk calculator (2016 European Society of Cardiology/European Society of Atherosclerosis guidelines) were calculated. The SCORE risk value was adjusted by a multiplication factor of 1.5. The recommendations for the indication of statins suggested by both guidelines were analyzed.ResultsA total of 892 patients (mean age 59.9 ± 16.5 years, 54.5% women) were included. The median atherosclerotic cardiovascular disease calculator and Systematic Coronary Risk Evaluation values were 13.4% (IQR 6.1–27.0%) and 1.9% (IQR 0.4–5.2), respectively. According to the atherosclerotic cardiovascular disease calculator, 20.1%, 11.0%, 32.9%, and 36.4% of the population was classified at low, borderline, moderate, or high risk. Applying the Systematic Coronary Risk Evaluation, 26.5%, 42.9%, 20.8%, and 9.8% of patients were stratified as having low, moderate, high, or very high risk, respectively. The proportion of subjects with statin indication was similar using both strategies: 60.1% and 60.9% for the 2018 American College of Cardiology/American Heart Association and 2016 European Society of Cardiology/European Society of Atherosclerosis guidelines, respectively.Study limitationsThis was a secondary database study. Data on the severity of psoriasis and pharmacological treatments were not included in the analysis.ConclusionThis population with psoriasis was mostly classified at moderate–high risk and the statin therapy indication was similar when applying the two strategies evaluated.

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“…Our study has limitations because of the retrospective design, the low number of patients with CV events and the fact that we had only insufficient data to evaluate the association of RDW, MTX therapy and CV events with other important variables including classical CV factors, the implication of a genetic component, or iron homeostasis [11, 30, 31]. In this regard, patients with RA who carried the methylene tetrahydrofolate reductase (MTHFR) 1298 allele C frequency were previously found to have an increased frequency of CV events after 5 and 10 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Methotrexate therapy impacts on red cell distribution width and its predictive value for cardiovascular events in patients with rheumatoid arthritis

Held

Mosheimer-Feistritzer

Gruber

et al. 2018

BMC Rheumatol

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Background Methotrexate (MTX) is well known to affect folic acid metabolism, so MTX treatment can result in alterations of mean corpuscular volume (MCV), which may impact on red cell distribution width (RDW), as MCV levels feed into RDW calculation. We thus questioned whether RDW levels and subsequently its diagnostic utility in RA subjects, as reported before, are influenced by ongoing MTX therapy. We assessed the impact of disease modifying drug (DMARD) treatment, especially MTX, on RDW and evaluated their influence on the predictive value of RDW for cardiovascular (CV) events in patients with rheumatoid arthritis (RA). As far as we know, this is the first study evaluating the influence of MTX on RDW. Methods Medical treatment, disease activity, laboratory parameters and history of CV events were retrospectively analysed in 385 RA patients at disease onset and at last follow up at our clinic. Additionally, in patients with CV event, data were recorded at last follow up prior the CV event. Results Disease parameters and laboratory findings associated with a serious vascular event were older age ( p < 0,001), longer disease duration ( p = 0,002) and a higher RDW at diagnosis ( p = 0,025). No differences in RDW levels became evident with any other treatment regimen beside MTX. MTX treated patients had significantly higher RDW compared to subjects without this drug ( p < 0,001). In RA patients without MTX treatment, we found RDW level significantly different between those with versus without a CV event, whereas this difference disappeared in subjects receiving MTX. Conclusion MTX impacts on RDW and might therefor reduce its prognostic value for CV events in patients taking MTX, whereas an increased RDW at diagnosis remains an early risk predictor for myocardial infarction and stroke in RA patients.

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Cardiovascular disease in immune-mediated inflammatory diseases

Abstract: Supplemental Digital Content is available in the text

Cited by 35 publications

References 35 publications

Increased Risk of Hypertension Associated with Spondyloarthritis Disease Duration: Results from the ASAS-COMOSPA Study

Increased Risk of Hypertension Associated with Spondyloarthritis Disease Duration: Results from the ASAS-COMOSPA Study

Should all patients with psoriasis receive statins? Analysis according to different strategies

Methotrexate therapy impacts on red cell distribution width and its predictive value for cardiovascular events in patients with rheumatoid arthritis

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