The risk of coronary heart disease for chronic inflammatory diseases varied widely, with the highest risk of systemic lupus erythematosus, and psoriasis and inflammatory bowel disease were not associated with an increased risk of cardiovascular disease

Current AHA/ACC guidelines list three chronic inflammatory diseases as risk factors for atherosclerotic cardiovascular disease: rheumatoid arthritis, psoriasis, and HIV infection.
, however, Dr. Arjun Sinha, a cardiologist at Northwestern University in Chicago, presented a virtual meeting of the American Heart Association's Annual Scientific Meeting (AHA 2020) in 2020 on three other diseases marked by elevated hypersensitivity to C-reactive proteins (hs-CRP) (systemic sclerosis, inflammatory bowel disease, and Studies of systemic lupus erythematosus (SLE) have shown that the associated risks of chronic inflammatory diseases and coronary heart disease (CHD) are not single, with two of the six inflammatory diseases (psoriasis and inflammatory bowel disease) not associated with an increased risk of cardiovascular disease, while the most at-risk disease is SLE, which is not specifically mentioned in the guidelines.
the study was awarded the Samuel A. Levine Early Career Clinical Investors Award by the American Heart Association (AHA) in 2020.
the study was a large case-control study that included 18,129 patients with six chronic inflammatory diseases and 18,988 matching control group patients who did not have CHD at the baseline test.
from 2000 to 2019, all subjects received regular outpatient treatment at Northwestern University.
1011 CHD events occurred during an average of 3.5 years of follow-up.
Based on demographic, insurance status, hypertension, diabetes, current smoking, total cholesterol and an adjusted rate of renal cystic filtration, the following is a cumulative risk of chronic inflammatory diseases in CHD and myocardial infarction (MI): SLE: CHD risk ratio (HR) is 2.85; MI HR is 4.76; systemic sclerosis: CHD's HR is 2.14; MI's HR is 3.19; HIV:CHD's HR is 1.38; MI's HR is 1.69; rheumatoid arthritis: CHD's HR is 1.22; MI's HR is 1.45; psoriasis: no significant increase; inflammatory bowel disease: no significant increase.
an exploratory analysis, Dr Sinha and others assessed the risk of CHD and layered it according to the severity of the disease.
the lack of standardized disease severity scales, the researchers relied on the triumte of the CD4 T cell count in the HIV group and the CRP in other groups.
of more than 5,000 psoriasis patients, the HR of the new CHD did not change due to the CRP tri-digit.
, however, in the HIV and inflammatory bowel disease groups, the increased severity of the disease associated with an increased risk of CHD was not significant as reflected in the CRP triumnational scale.
In contrast, the risk of CHD was significantly higher in patients with rheumatoid arthritis or systemic sclerosis with the highest TRIPLE, with HRs of 2.11 in rheumatoid arthritis and 4.59 in patients with systemic sclerosis, although there was no significant increase in risk in the other two tri-level patients.
, however, all three triplets of CRP in SLE patients were associated with a significant increase in CHD risk: the lowest trielement of lupus was 3.17 times, the median trielement was 5.38 times, and the highest trielement of inflammation was 4.04 times.
these findings can be used in clinical practice to adjust the risk assessment of atherosclerotic cardiovascular diseases based on the type and severity of chronic inflammatory diseases.
, this information in turn helps guide the timing and intensity of preventive treatment for patients of each disease type.
, Dr Sinha believes there are other uses for studying the relationship between chronic systemic inflammatory diseases and CHD risk.
these inflammatory diseases can be used as models for atherosclerosis, revealing mechanisms associated with cardiovascular disease and non-lipids.
, dr. Sinha said, these six chronic inflammatory diseases are characterized by different forms of major immune dysfunction.
example is SLE, an inflammatory disease associated with the highest risk of CHD and MI.
lupus is characterized by neural granulocyte dysfunction, characterized by a decrease in the formation and degradation of neural granulocyte extracellular mesh traps (NETs), as well as an increase in its own reactive B-cells and dysfunctional CD4-T-assisted cells.
particular concern is the increase in NETs, which have also been shown to contribute to the development of atherosclerosis, endothostic dysfunction, plaque erosion and thrombosis.
in another exploratory analysis, Dr Sinha and others found that patients with sLE with a neutral granulocyte count above the median were twice as likely to develop CHD as patients with a neutral granulocyte count below the median. Dr
Sinha said a better understanding of the upstream pathps associated with systemic lupus erythematosus (SLE) and NET formation of atherosclerosis could lead to the development of new or reused drugs for immune disorders to inhibit atherosclerosis.
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