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Chronic Inflammatory-Related Disease and Cardiovascular Disease in MESA
Evan S Manning1, Gautam R Shroff2, David R Jacobs3
1Cardiovascular Division, Department of Medicine, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Insights
Chronic inflammatory-related diseases (ChrIRD) are common and significantly increase mortality risk, especially when combined with cardiovascular disease (CVD). This bidirectional relationship highlights inflammation
Area of Science:
- Cardiovascular disease research
- Inflammation and chronic disease epidemiology
Background:
- Inflammation is a key factor in cardiovascular disease (CVD) development.
- Chronic inflammatory-related diseases (ChrIRD) encompass diverse non-cardiovascular, non-cancerous conditions.
- The interplay between ChrIRD and CVD was investigated in the Multi-Ethnic Study of Atherosclerosis (MESA).
Purpose of the Study:
- To define and describe chronic inflammatory-related diseases (ChrIRD).
- To examine the association between ChrIRD and cardiovascular disease (CVD).
- To investigate the relationship between ChrIRD, CVD, and mortality.
Main Methods:
- Analysis of 6,791 MESA participants free of overt CVD at baseline.
- Follow-up duration of 17.9 years (median).
- ChrIRD identification via ICD codes from hospitalization and death records; CVD adjudication from medical records.
- Time-dependent proportional hazard regressions used to assess risks.
Main Results:
- ChrIRD prevalence was 29%, CVD prevalence was 21%, and 11% had both conditions.
- Mortality rates were 47% for ChrIRD only, 45% for CVD only, and 67% for both.
- CVD increased ChrIRD risk (HR: 1.48), and ChrIRD increased CVD risk (HR: 2.23).
- Baseline inflammatory markers predicted both ChrIRD and CVD.
Conclusions:
- ChrIRD is prevalent across organ systems and strongly linked to mortality, particularly with co-existing CVD.
- A bidirectional relationship exists between CVD and ChrIRD.
- Inflammatory markers at baseline are predictive of both ChrIRD and CVD development.
Background:
Inflammation plays a role in cardiovascular disease (CVD). We defined various noncardiovascular and noncancer conditions, both infectious and noninfectious, with a common basis of inflammation, collectively termed chronic inflammatory-related disease (ChrIRD). We describe ChrIRD and its interplay with CVD during follow-up in the Multi-Ethnic Study of Atherosclerosis.
Objectives:
The aim of the study was to describe ChrIRD, its associations with CVD, and its association with mortality.
Methods:
Participants were free of overt CVD at baseline with median 17.9 (Q1-Q3: 14.9-18.6) years of follow-up. ChrIRD was determined by review of hospitalization and death records of International Classification of Diseases codes. CVD diagnosis was adjudicated based on medical records. We performed time-dependent proportional hazard regressions to identify risks related to ChrIRD or CVD events.
Results:
MESA (Multi-Ethnic Study of Atherosclerosis) participants (n = 6,791) had a mean age of 62 ± 10 years, with 47% (3,201/6,791) men, 39% (2,617/6,791) White, 28% (1,882/6,791) Black, 22% (1,489/6,791) Hispanic, and 12% (803/6,791) Chinese race/ethnicity. ChrIRD was observed in 29% (1,965/6,791) and CVD in 21% (1,420/6,791); including 11% (761/6,791) with both conditions. Mortality after ChrIRD only was 47% (567/1,204; 95% CI: 44%-49%); after CVD only was 45% (300/659; 95% CI: 41%-49%); and after both conditions was 67% (510/761; 95% CI: 63%-70%). CVD was associated with increased risk of ChrIRD (HR: 1.48; 95% CI: 1.23-1.77) and ChrIRD was associated with increased risk of CVD (HR: 2.23; 95% CI: 1.97-2.52). Baseline inflammatory markers predicted both conditions.
Conclusions:
ChrIRD is common, present in all organ systems, and is associated with significant mortality, particularly in combination with CVD. The association between CVD and ChrIRD is bidirectional, and baseline inflammatory markers are associated with ChrIRD and CVD.
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