Association of Autoimmune Diseases With Coronary Atherosclerosis Severity and Ischemic Events,Journal of the American College of Cardiology

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Association of Autoimmune Diseases With Coronary Atherosclerosis Severity and Ischemic Events
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2024-06-17 , DOI: 10.1016/j.jacc.2024.04.030
Martin Bødtker Mortensen ₁ , Jesper Møller Jensen ₂ , Niels Peter Rønnow Sand ₃ , Kristian Kragholm ₄ , Michael J Blaha ₅ , Erik Lerkevang Grove ₂ , Henrik Toft Sørensen ₆ , Kevin Olesen ₂ , Michael Maeng ₇ , Brian Løgstrup ₂ , Martin Busk ₈ , Ellen Margrethe Hauge ₉ , Ann Marie Navar ₁₀ , Hans Erik Bøtker ₂ , Bjarne Linde Nørgaard ₂

Affiliation

Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Cardiology, University Hospital of Southwest Jutland and Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark.
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark.
Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Some autoimmune diseases carry elevated risk for atherosclerotic cardiovascular disease (ASCVD), yet the underlying mechanism and the influence of traditional risk factors remain unclear. This study sought to determine whether autoimmune diseases independently correlate with coronary atherosclerosis and ASCVD risk and whether traditional cardiovascular risk factors modulate the risk. The study included 85,512 patients from the Western Denmark Heart Registry undergoing coronary computed tomography angiography. A diagnosis of 1 of 18 autoimmune diseases was assessed. Adjusted OR (aOR) for any plaque, any coronary artery calcification (CAC), CAC of >90th percentile, and obstructive coronary artery disease as well as adjusted HR (aHR) for ASCVD were calculated. During 5.3 years (Q1-Q3: 2.8-8.2 years) of follow-up, 3,832 ASCVD events occurred. A total of 4,064 patients had a diagnosis of autoimmune disease, which was associated with both presence of any plaque (aOR: 1.29; 95% CI: 1.20-1.40), any CAC (aOR: 1.28; 95% CI: 1.19-1.37), and severe CAC of >90th percentile (aOR: 1.53; 95% CI: 1.39-1.68), but not with having obstructive coronary artery disease (aOR: 1.04; 95% CI: 0.91-1.17). Patients with autoimmune diseases had a 46% higher risk (aHR: 1.46; 95% CI: 1.29-1.65) for ASCVD. Traditional cardiovascular risk factors were strongly associated with future ASCVD events, and a favorable cardiovascular risk factor profile in autoimmune patients was associated with ∼54% lower risk compared to patients with presence of risk factors (aHR: 0.46; 95% CI: 0.27-0.81). Autoimmune diseases were independently associated with higher burden of coronary atherosclerosis and higher risk for future ASCVD events, with risk accentuated by traditional cardiovascular risk factors. These findings suggest that autoimmune diseases increase risk through accelerated atherogenesis and that cardiovascular risk factor control is key for improving prognosis in patients with autoimmune diseases.

中文翻译：

自身免疫性疾病与冠状动脉粥样硬化严重程度和缺血事件的关联

一些自身免疫性疾病导致动脉粥样硬化性心血管疾病（ASCVD）的风险较高，但其潜在机制和传统危险因素的影响仍不清楚。本研究旨在确定自身免疫性疾病是否与冠状动脉粥样硬化和 ASCVD 风险独立相关，以及传统心血管危险因素是否会调节风险。该研究纳入了来自丹麦西部心脏登记处的 85,512 名接受冠状动脉计算机断层扫描血管造影的患者。对 18 种自身免疫性疾病中的 1 种进行了诊断评估。计算任何斑块、任何冠状动脉钙化 (CAC)、>90% 的 CAC 和阻塞性冠状动脉疾病的调整 OR (aOR) 以及 ASCVD 的调整 HR (aHR)。在 5.3 年（第一季度至第三季度：2.8-8.2 年）的随访期间，发生了 3,832 例 ASCVD 事件。共有 4,064 名患者被诊断为自身免疫性疾病，这与任何斑块（aOR：1.29；95% CI：1.20-1.40）和任何 CAC（aOR：1.28；95% CI：1.19-1.37）的存在相关。，以及>90%的严重CAC（aOR：1.53；95% CI：1.39-1.68），但不伴有阻塞性冠状动脉疾病（aOR：1.04；95% CI：0.91-1.17）。患有自身免疫性疾病的患者发生 ASCVD 的风险高出 46%（aHR：1.46；95% CI：1.29-1.65）。传统的心血管危险因素与未来的 ASCVD 事件密切相关，与存在危险因素的患者相比，自身免疫患者良好的心血管危险因素状况与风险降低约 54% 相关（aHR：0.46；95% CI：0.27-0.81 ）。自身免疫性疾病与较高的冠状动脉粥样硬化负担和较高的未来 ASCVD 事件风险独立相关，传统心血管危险因素会加剧风险。这些发现表明，自身免疫性疾病通过加速动脉粥样硬化形成而增加风险，心血管危险因素控制是改善自身免疫性疾病患者预后的关键。

更新日期：2024-06-17

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