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Risk of atherosclerosis-related diseases in polymyositis and dermatomyositis patients: A large-scale population-based
Lior Fisher1, Niv Ben-Shabat1, Omer Gendelman1
1Department of Internal Medicine B & Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Insights
Polymyositis (PM) and dermatomyositis (DM) increase the risk of heart attack and stroke. Patients with PM/DM and APLA-associated antibodies face even higher Atherosclerotic Cardiovascular Disease (ASCVD) rates.
Area of Science:
- Rheumatology
- Cardiology
- Neurology
Background:
- Systemic autoimmune diseases, including polymyositis (PM) and dermatomyositis (DM), are linked to increased Atherosclerotic Cardiovascular Disease (ASCVD).
- Inflammation plays a crucial role in atherogenesis, but the specific association between PM/DM and ASCVD events remains underexplored.
Purpose of the Study:
- To investigate the association between PM/DM and ASCVD events.
- To examine the incidence, mortality, and interaction of disease-modifying agents, autoantibodies, and traditional cardiovascular disease (CVD) risk factors in a large population-based sample.
Main Methods:
- A retrospective cohort study was conducted using electronic health records from Clalit Health Services (CHS).
- 1899 PM/DM patients diagnosed between 2000-2016 were matched with 7676 healthy controls (1:5 ratio) by age and sex.
- ASCVD incidence was compared between groups using univariate and multivariate models, adjusting for baseline CVD risk factors.
Main Results:
- PM/DM patients had a significantly higher incidence of ischemic heart disease (IHD) (HR 1.61) and cerebrovascular accident (CVA) (HR 2.45) compared to controls.
- The overall risk for ASCVD was elevated in the PM/DM group (HR 1.75).
- Patients with PM/DM positive for APLA-associated antibodies showed a significantly higher ASCVD risk (OR 2.33).
Conclusions:
- Polymyositis and dermatomyositis are associated with an increased risk of IHD and CVA.
- PM/DM patients with APLA-associated antibodies exhibit particularly high rates of ASCVD.
- Increased awareness and surveillance for cardiovascular, neurological, and vascular outcomes are warranted for PM/DM patients.
Background And Aims:
Several systemic autoimmune diseases predispose to the enhancement of Atherosclerotic Cardiovascular Disease (ASCVD). These findings underline the role of inflammation in atherogenesis. Dermatomyositis (DM) and polymyositis (PM) are polygenic autoimmune disorders involving mainly skeletal muscles. The association between PM/DM and ASCVD has not been well addressed and explored. We aimed to investigate the association between PM/DM and ASCVD events, we examined the incidence, mortality, and interaction of disease-modifying agents, autoantibodies, and traditional cardiovascular disease (CVD) risk factors in a large population-based sample.
Methods:
We conducted a retrospective cohort study using the electronic database of Clalit Health Services (CHS), the largest health organization in Israel. All DM and PM patients diagnosed between 2000 and 2016 were included and matched with healthy controls by age and sex in a 1:5 ratio. Follow-up continued until the first diagnosis of ASCVD or death. The incidence of ASCVD was compared between the groups using univariate and multivariate models adjusting for baseline cardiovascular risk factors.
Results:
The study population included 1899 PM/DM patients and 7676 controls. The mean age at the index date was 32.5 years (SD ± 19 years), and the female proportion was 60.3 %, similar for both groups. Traditional cardiovascular risk factors were similar in both groups. The Median follow-up time was 8.4 years (3.6-12.8) in the PM/DM group compared to 8.6 (3.7-12.9) in the control group. 47 (3.0 %) PM/DM patients were diagnosed with ischemic heart disease (IHD) compared to 1.8 % (140) in the controls, yielding a multivariate HR (95%CI) of 1.61 (1.15-2.25). Multivariate HR for cerebrovascular accident (CVA) in the PM/DM group was (95%CI) 2.45 (1.63-3.70). Multivariate HR for ASCVD. (95%CI) was 1.75 (1.35-2.27) in the PM/DM group. APLA-associated antibodies presence was more associated with ASCVD among PM/DM groups than non-ASCVD PM and DM patients (OR 2.33, 95 % CI 1.41-3.86, p < 0.001).
Conclusions:
Our study demonstrates that PM and DM are associated with an increased risk of IHD and CVA. Furthermore, PM and DM patients positive for APLA-associated antibodies exhibited excessive rates of ASCVD. These findings support the increased need for awareness and surveillance of cardiological, neuronal, and vascular outcomes in patients suffering from PM/DM.
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