Top

Clinical Rheumatology

Published in:

Open Access 01-01-2021 | Polymyositis | Original Article

Similar risk of cardiovascular events in idiopathic inflammatory myopathy and rheumatoid arthritis in the first 5 years after diagnosis

Authors: Cristina Párraga Prieto, Fowzia Ibrahim, Richard Campbell, Hector Chinoy, James Galloway, Patrick Gordon

Published in: Clinical Rheumatology | Issue 1/2021

Abstract

Objectives

To estimate the incidence of cardiovascular (CV) events in idiopathic inflammatory myopathy (IIM) compared to patients with rheumatoid arthritis (RA) and the general population. To explore the contribution of traditional CV risk factors to any difference observed.

Methods

A retrospective matched population-based cohort study was conducted using UK Clinical Practice Research Datalink (CPRD) from 1987 to 2013. The incidence of CV events was calculated for each cohort over time and compared using Cox proportional hazards models. Multivariable analyses were used to adjust for traditional CV risk factors.

Results

A total of 603 patients with IIM 4047 RA and 4061 healthy controls were included. The rate of CV events in IIM was significantly greater than healthy controls [hazard ratio (HR) 1.47 (95% confidence interval (CI) 1.18–1.83)] and remained significant after adjustment for CV risk factors [HR 1.38 (95% CI 1.11–1.72)]. Risk was similar between IIM and RA [HR 1.01 (95% CI 0.78–1.31)]. The rate of myocardial infarction [HR 1.61 (95% CI 1.27–2.04)] but not stroke [HR 0.92 (95% CI 0.59–1.44)] was significantly greater in IIM compared to healthy controls. After the first 5 years, the rate of CV events for RA remained significantly greater compared to the control group, but appeared to return to that of the healthy controls in the IIM group.

Conclusion

IIM is associated with an increased risk of CV events in the first 5 years after diagnosis similar to that of RA. Beyond 5 years, the risk appears to return to that of the general population in IIM but not RA.

Key Points

• The excess risk of cardiovascular events in IIM is similar to that found in RA.

• The excess risk of cardiovascular events is greatest in the first 5 years after diagnosis.

Skaggs BJ, Hahn BH, McMahon M (2012) Accelerated atherosclerosis in patients with SLE--mechanisms and management. Nat Rev Rheumatol 8(4):214–223CrossRef

Skeoch S, Bruce IN (2015) Atherosclerosis in rheumatoid arthritis: is it all about inflammation? Nat Rev Rheumatol 11(7):390–400CrossRef

Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB (2006) Risk of myocardial infarction in patients with psoriasis. JAMA. 296(14):1735–1741CrossRef

Esdaile JM, Abrahamowicz M, Grodzicky T, Li Y, Panaritis C, du Berger R, Côte R, Grover SA, Fortin PR, Clarke AE, Senécal JL (2001) Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum 44(10):2331–2337CrossRef

del Rincón ID, Williams K, Stern MP, Freeman GL, Escalante A (2001) High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum 44(12):2737–2745CrossRef

Eder L, Chandran V, Gladman DD (2014) The Framingham risk score underestimates the extent of subclinical atherosclerosis in patients with psoriatic disease. Ann Rheum Dis 73(11):1990–1996CrossRef

Fischer LM, Schlienger RG, Matter C, Jick H, Meier CR (2004) Effect of rheumatoid arthritis or systemic lupus erythematosus on the risk of first-time acute myocardial infarction. Am J Cardiol 93(2):198–200CrossRef

Studynkova JT, Mann H, Jarosova K et al (2014) A prospective, randomized, open-label, assessor-blind, multicenter study of efficacy and safety of combined treatment of methotrexate + glucocorticoids versus glucocorticoids alone in patients with polymyositis and dermatomyositis (prometheus trial). Ann Rheum Dis 73(Suppl 2)

De Bandt M, Sibilia J, Le Loët X et al (2005) Systemic lupus erythematosus induced by anti-tumour necrosis factor alpha therapy: a French national survey. Arthritis Res Ther. 7(3):R545–R551CrossRef

10.

Higgs BW, Liu Z, White B, Zhu W, White WI, Morehouse C, Brohawn P, Kiener PA, Richman L, Fiorentino D, Greenberg SA, Jallal B, Yao Y (2011) Patients with systemic lupus erythematosus, myositis, rheumatoid arthritis and scleroderma share activation of a common type I interferon pathway. Ann Rheum Dis 70(11):2029–2036CrossRef

11.

Magro CM, Segal JP, Crowson AN, Chadwick P (2010) The phenotypic profile of dermatomyositis and lupus erythematosus: a comparative analysis. J Cutan Pathol 37(6):659–671CrossRef

12.

Somers EC, Zhao W, Lewis EE, Wang L, Wing JJ, Sundaram B, Kazerooni EA, McCune WJ, Kaplan MJ (2012) Type I interferons are associated with subclinical markers of cardiovascular disease in a cohort of systemic lupus erythematosus patients. PLoS One 7(5):e37000CrossRef

13.

Vincze M, Dér H, Kerekes G et al (2014) Decreased flow-mediated dilatation with increased arterial stiffness and thickness as early signs of atherosclerosis in polymyositis and dermatomyositis patients. Clin Rheumatol 33(11):1635–1641CrossRef

14.

Herrett E, Gallagher AM, Bhaskaran K, Forbes H, Mathur R, van Staa T, Smeeth L (2015) Data resource profile: clinical practice research Datalink (CPRD). Int J Epidemiol 44(3):827–836CrossRef

15.

Herrett E, Thomas SL, Schoonen WM, Smeeth L, Hall AJ (2010) Validation and validity of diagnoses in the general practice research database: a systematic review. Br J Clin Pharmacol 69:4–14CrossRef

16.

Abhishek A, Nakafero G, Kuo CF, Mallen C, Zhang W, Grainge MJ, Doherty M (2018) Rheumatoid arthritis and excess mortality: down but not out. A primary care cohort study using data from clinical practice research Datalink. Rheumatology (Oxford) 57(6):977–981CrossRef

17.

Lai YT, Dai YS, Yen MF, Chen LS, Chen HH, Cooper RG, Pan SL (2013) Dermatomyositis is associated with an increased risk of cardiovascular and cerebrovascular events: a Taiwanese population-based longitudinal follow-up study. Br J Dermatol 168(5):1054–1059CrossRef

18.

Yu KH, See LC, Kuo CF, Chou IJ, Chou MJ (2013) Prevalence and incidence in patients with autoimmune rheumatic diseases: a nationwide population-based study in Taiwan. Arthritis Care Res (Hoboken) 65(2):244–250CrossRef

19.

Zöller B, Li X, Sundquist J, Sundquist K (2012) Risk of subsequent coronary heart disease in patients hospitalized for immune-mediated diseases: a nationwide follow-up study from Sweden. PLoS One 7(3):e33442CrossRef

20.

Tisseverasinghe A, Bernatsky S, Pineau CA (2009) Arterial events in persons with dermatomyositis and polymyositis. J Rheumatol 36(9):1943–1946CrossRef

21.

Rai SK, Choi HK, Sayre EC, Aviña-Zubieta JA (2016) Risk of myocardial infarction and ischaemic stroke in adults with polymyositis and dermatomyositis: a general population-based study. Rheumatology (Oxford) 55(3):461–469

22.

Finsterer J, Stöllberger C (2010) Stroke in myopathies. Cerebrovasc Dis 29:6–13CrossRef

23.

Finsterer J (2012) Stroke and stroke-like episodes in muscle disease. Open Neurol J 6:26–36CrossRef

24.

England BR, Thiele GM, Anderson DR, Mikuls TR (2018) Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications. BMJ 361:k1036. https://doi.org/10.1136/bmj.k1036CrossRefPubMedPubMedCentral

25.

Schwartz T, Diederichsen LP, Lundberg IE, Sjaastad Iand Sanner H (2016) Cardiac involvement in adult and juvenile idiopathic inflammatory myopathies. RMD Open 2(2):e000291CrossRef

26.

Magder LS, Petri M (2012) Incidence of and risk factors for adverse cardiovascular events among patients with systemic lupus erythematosus. Am J Epidemiol 176(8):708–719CrossRef

27.

Peters MJ, Symmons DP, McCarey D, Dijkmans BA, Nicola P, Kvien TK, McInnes I, Haentzschel H, Gonzalez-Gay MA, Provan S, Semb A, Sidiropoulos P, Kitas G, Smulders YM, Soubrier M, Szekanecz Z, Sattar N, Nurmohamed MT (2010) EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 69(2):325–331CrossRef

28.

Innala L, Möller B, Ljung L, Magnusson S, Smedby T, Södergren A, Öhman ML, Rantapää-Dahlqvist S, Wållberg-Jonsson S (2011) Cardiovascular events in early RA are a result of inflammatory burden and traditional risk factors: a five year prospective study. Arthritis Res Ther 13(4):R131CrossRef

29.

Sultan SM, Ioannou Y, Moss K, Isenberg DA (2002) Outcome in patients with idiopathic inflammatory myositis: morbidity and mortality. Rheumatology (Oxford) 41(1):22–26CrossRef

30.

Sanner H, Sjaastad I, Flatø B (2014) Disease activity and prognostic factors in juvenile dermatomyositis: a long-term follow-up study applying the Paediatric rheumatology international trials organization criteria for inactive disease and the myositis disease activity assessment tool. Rheumatology (Oxford) 53(9):1578–1585CrossRef

31.

Hughes M, Lilleker JB, Herrick AL, Chinoy H (2015) Cardiac troponin testing in idiopathic inflammatory myopathies and systemic sclerosis-spectrum disorders: biomarkers to distinguish between primary cardiac involvement and low-grade skeletal muscle disease activity. Ann Rheum Dis 74(5):795–798CrossRef

32.

Lilleker JB, Diederichsen ACP, Jacobsen S, Guy M, Roberts ME, Sergeant JC, Cooper RG, Diederichsen LP, Chinoy H (2018) Using serum troponins to screen for cardiac involvement and assess disease activity in the idiopathic inflammatory myopathies. Rheumatology (Oxford) 57(6):1041–1046CrossRef

33.

Rosenbohm A, Buckert D, Gerischer N, Walcher T, Kassubek J, Rottbauer W, Ludolph AC, Bernhardt P (2015) Early diagnosis of cardiac involvement in idiopathic inflammatory myopathy by cardiac magnetic resonance tomography. J Neurol 262(4):949–956CrossRef

34.

Van Staa TP, Leufkens HGM, Abenhaim L, Begaud B, Zhang B, Cooper C (2000) Use of oral corticosteroids in the United Kingdom. QJM 93(2):105–111CrossRef

35.

Lundberg IE, Forbess CJ (2008) Mortality in idiopathic inflammatory myopathies. Clin Exp Rheumatol 26(5 Suppl 51):S109–S114PubMed

36.

Gupta R, Wayangankar SA, Targoff IN, Hennebry TA (2011) Clinical cardiac involvement in idiopathic inflammatory myopathies: a systematic review. Int J Cardiol 148(3):261–270CrossRef

37.

Zhang L, Wang GC, Ma L, Zu N (2012) Cardiac involvement in adult polymyositis or dermatomyositis: a systematic review. Clin Cardiol 35(11):686–691PubMed

38.

Bazzani C, Cavazzana I, Ceribelli A, Vizzardi E, Dei Cas L, Franceschini F (2010) Cardiological features in idiopathic inflammatory myopathies. J Cardiovasc Med (Hagerstown) 11(12):906–911CrossRef

39.

Linos E, Fiorentino D, Lingala B, Krishnan E, Chung L (2013) Atherosclerotic cardiovascular disease and dermatomyositis: an analysis of the Nationwide inpatient sample survey. Arthritis Res Ther 15(1):R7CrossRef

Title: Similar risk of cardiovascular events in idiopathic inflammatory myopathy and rheumatoid arthritis in the first 5 years after diagnosis
Authors: Cristina Párraga Prieto
Fowzia Ibrahim
Richard Campbell
Hector Chinoy
James Galloway
Patrick Gordon
Publication date: 01-01-2021
Publisher: Springer International Publishing
Keywords: Polymyositis
Diseases of the neuromuscular synapses and muscles
Polymyositis
Arterial Occlusive Disease
Rheumatoid Arthritis
Dermatomyositis
Myopathy
Published in: Clinical Rheumatology / Issue 1/2021
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-020-05237-7

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Similar risk of cardiovascular events in idiopathic inflammatory myopathy and rheumatoid arthritis in the first 5 years after diagnosis

Abstract

Objectives

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Outcome of pulse oral cyclophosphamide therapy in scleroderma interstitial lung disease

Dural ectasias in ankylosing spondylitis

Reductions of cardiovascular and metabolic risk factors after a 14-week periodized training model in patients with knee osteoarthritis: a randomized controlled trial

A case of cryopyrin-associated periodic fever syndrome during canakinumab administration complicated by inflammatory bowel disease

Longitudinal change during follow-up of systemic sclerosis: correlation between high-resolution computed tomography and pulmonary function tests

Measurement properties of Pain Catastrophizing Scale in patients with knee osteoarthritis

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page