比利时鲁汶大学Nathalie Conrad团队研究了自身免疫性疾病和心血管风险的相关性。2022年8月27日，《柳叶刀》杂志发表了这一成果。

一些自身免疫性疾病与心血管疾病风险增加相关。该研究旨在确定该相关性对于广泛的自身免疫性疾病来说是否正确，以及在多大程度上正确。

在这项基于人群的研究中，研究组使用来自临床实践研究数据链（CPRD）、GOLD和Aurum数据集的相关初级和二级保健记录，2000年1月1日至2017年12月31日，在英国收集了一组新诊断出19种自身免疫性疾病中任何一种的患者，诊断时年龄小于80岁，诊断后12个月内无心血管疾病。

研究组还收集了一个匹配队列，其中多达五组个体在年龄、性别、社会经济地位、地区和日历年方面匹配，他们在研究进入后12个月内没有自身免疫疾病和心血管疾病。这两个队列均被随访至2019年6月30日。研究组调查了12种心血管结局的发生率，并使用Cox比例风险模型来检查有无自身免疫性疾病患者的差异。

在CPRD数据库中确定的22009375名个体中，研究组确定了446449名有自身免疫性疾病的合格个体和2102830名匹配对照者。在自身免疫队列中，平均诊断年龄为46.2岁，女性271410人（60.8%），男性175039人（39.2%）。

68413名（15.3%）患有自身免疫性疾病的患者和231410名（11.0%）未患有自身免疫疾病的患者在中位6.2年的随访中发生心血管疾病。自身免疫性疾病患者的心血管病发病率为23.3/1000患者-年，而非自身免疫性疾病患者为15.0/1000患者，危险比（HR）为1.56。

每一种心血管疾病中自身免疫性心血管疾病风险均增加，并随着自身免疫性疾病的出现而逐渐增加（一种疾病：HR为1.41；两种疾病为2.63；三种及以上疾病为3.79），年轻年龄组的风险亦增加（年龄<45岁：HR为2.33；55-64岁为1.76；≥75岁为1.30）。在自身免疫性疾病中，系统性硬化症（3.59）、艾迪森氏病（2.83）、系统性红斑狼疮（2.82）和1型糖尿病（2.36）的总体心血管风险最高。

该研究证明了亟需采取有针对性的心血管预防措施，特别是对于患有自身免疫性疾病的年轻患者，并进一步研究这些并发症的病理生理机制。

附：英文原文

Title: Autoimmune diseases and cardiovascular risk: a population-based study on 19 autoimmune diseases and 12 cardiovascular diseases in 22 million individuals in the UK

Author: Nathalie Conrad, Geert Verbeke, Geert Molenberghs, Laura Goetschalckx, Thomas Callender, Geraldine Cambridge, Justin C Mason, Kazem Rahimi, John J V McMurray, Jan Y Verbakel

Issue&Volume: 2022-08-27

Abstract:

Background

Some autoimmune diseases are associated with an increased risk of cardiovascular disease. We aimed to determine whether or not this is true, and to what extent, for a broad range of autoimmune conditions.

Methods

In this population-based study, we used linked primary and secondary care records from the Clinical Practice Research Datalink (CPRD), GOLD and Aurum datasets, to assemble a cohort of individuals across the UK who were newly diagnosed with any of 19 autoimmune diseases between Jan 1, 2000, and Dec 31, 2017, younger than 80 years at diagnosis, and free of cardiovascular diseases up to 12 months after diagnosis. We also assembled a matched cohort with up to five individuals matched on age, sex, socioeconomic status, region, and calendar year, who were free of autoimmune disease and free of cardiovascular diseases up to 12 months after study entry. Both cohorts were followed up until June 30, 2019. We investigated the incidence of 12 cardiovascular outcomes and used Cox proportional hazards models to examine differences in patients with and without autoimmune diseases.

Findings

Of 22009375 individuals identified from the CPRD databases, we identified 446449 eligible individuals with autoimmune diseases and 2102830 matched controls. In the autoimmune cohort, mean age at diagnosis was 46·2 years (SD 19·8), and 271410 (60·8%) were women and 175039 (39·2%) were men. 68413 (15·3%) people with and 231410 (11·0%) without autoimmune diseases developed incident cardiovascular disease during a median of 6·2 years (IQR 2·7–10·8) of follow-up. The incidence rate of cardiovascular disease was 23·3 events per 1000 patient-years among patients with autoimmune disease and 15·0 events per 1000 patient-years among those without an autoimmune disease (hazard ratio [HR] 1·56 [95% CI 1·52–1·59]). An increased risk of cardiovascular disease with autoimmune disease was seen for every individual cardiovascular disease and increased progressively with the number of autoimmune diseases present (one disease: HR 1·41 [95% CI 1·37–1·45]; two diseases: 2·63 [2·49–2·78]); three or more diseases: 3·79 [3·36–4·27]), and in younger age groups (age <45 years: 2·33 [2·16–2·51]; 55–64 years: 1·76 [1·67–1·85]; ≥75 years: 1·30 [1·24–1·36]). Among autoimmune diseases, systemic sclerosis (3·59 [2·81–4·59]), Addison's disease (2·83 [1·96–4·09]), systemic lupus erythematosus (2·82 [2·38–3·33]), and type 1 diabetes (2·36 [2·21–2·52]) had the highest overall cardiovascular risk.

Interpretation

These findings warrant targeted cardiovascular prevention measures, in particular in younger patients with autoimmune diseases, and further research into pathophysiological mechanisms underlying these complications.

DOI: 10.1016/S0140-6736(22)01349-6

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01349-6/fulltext