Chronic Inflammatory Disorders and Risk of Type 2 Diabetes Mellitus, Coronary Heart Disease, and Stroke: A Population-Based Cohort Study
Background—The study aimed to evaluate whether risks of diabetes and cardiovascular disease (CVD) are elevated across a range of organ-specific and multi-system chronic inflammatory disorders.
Methods and Results—A matched cohort study was implemented in the UK Clinical Practice Research Datalink (CPRD) including participants with severe psoriasis (5,648), mild psoriasis (85,232), bullous skin diseases (4,284), ulcerative colitis (12,203), Crohn's disease (7,628), inflammatory arthritis (27,358), systemic autoimmune disorders (7,472), systemic vasculitis (6,283) and 373,851 matched controls. The main outcome measures were new diagnoses of type 2 diabetes mellitus (T2DM), stroke, or coronary heart disease (CHD). The outcomes were evaluated for each condition in a multiple outcomes model, adjusting for conventional cardiovascular risk factors. Estimates for different inflammatory conditions were pooled in a random effects meta-analysis. There were 4,695 new diagnoses of T2DM, 3,266 for CHD and 1,715 for stroke. The hazards for pooled multiple failure estimate was 1.20 (95% confidence interval (CI), 1.15-1.26). The highest relative hazards were observed in systemic autoimmune disorders (1.32, CI: 1.16-1.44) and systemic vasculitis (1.29, CI: 1.16-1.44). Hazards were increased in organ-specific disorders, including severe psoriasis (1.29, CI: 1.12-1.47) and ulcerative colitis (1.26, CI: 1.14-1.40). Participants in the highest tertile of CRP had greater risk of multiple outcomes (1.52, CI: 1.37-1.68).
Conclusions—The risk of cardiovascular diseases and T2DM is increased across a range of organ-specific and multi-system chronic inflammatory disorders with evidence that risk is associated with severity of inflammation. Clinical management of patients with chronic inflammatory disorders should aim to reduce cardiovascular risk.
- Received March 10, 2014.
- Revision received June 22, 2014.
- Accepted June 24, 2014.