Chronic inflammatory conditions carry a similar higher cardiovascular risk compared to the general population warranting screening.
S.Kirthi, M.Hussey, AM Tobin, D.McNamara
Departments of Gastroenterology and Dermatology, Tallaght Hospital and Trinity College Dublin
It is well recognised that chronic inflammatory diseases cause an increased risk of cardiovascular disease (CVD). The relative risk for different diseases is unknown. Investigation of the risk in a variety of conditions could help identify disease specific risk factors.
To determine the CVD risk among two cohorts with common inflammatory conditions, psoriasis (PD) and Crohn’s Disease (CD)
Patients with CD and PD with no history of CVD were prospectively recruited from IBD and Dermatology clinics. Noninflammatory controls without a history of CVD were recruited from outpatients. Demographic details, smoking history (pack years PY), disease severity (Harvey Bradshaw Index, HBI and Psoriasis Area Severity Index, PASI ) and diabetes were recorded at interview. Blood pressure and waist circumference (WC) were measured. Fasting lipid profile, glucose, insulin & homocysteine (Hcy) levels were obtained. Insulin resistance (IR) was calculated using the Homeostatic Model Assessment calculator. A Framingham risk (FR) was calculated predicting the 10 year risk of CVD , <10% low, 10-20% intermediate and >20% high risk and compared between groups, a p< 0.05 was considered significant.
To date 91 CD, 103 PD and 40 controls were recruited, mean age 40(range 19-69), 43(range 19-69) and 43(range 21-72) respectively. PD had a greater; percentage of men (51% vs 36%, p<0.04), disease duration (23 vs 13 years, p<0.0001), disease severity (mean PASI 10 vs HBI 1.5) and smoking history (11.5 vs 4.5 PY, p<0.006) compared to CD. Mean FR was 7.4% vs 5.4% vs 2.8% in PD, CD and control groups respectively. Overall frequency of a high FR was greater in patients with disease versus controls, 6.4 vs 3 (p<0.0001). There was also a higher mean BMI (26 vs 25, p<0.0001), WC (95.6 vs 89, p = 0.03), TG (1.32mmol/L vs 1mmol/L, p < 0.02), and smoking level (7.2 vs 1.4, p = 0.0005) between disease and control groups. The FR in CD versus Psoriasis however was not diferent (7.4 v 5.4). In addition there was no difference in most risk factors including glucose, HDL, high CRP, IR and homocysteine levels between disease groups apart for TG ( CD 1.5mmol/L vs 1.2mmol/L PD, p<0.01).
Our study confirms an increased risk of CVD in chronic inflammatory conditions. The CVD risks for both conditions was similar supporting a common multifactorial aetiology. NICE guidelines recommend that patients with severe psoriasis should have CVD screening a similar strategy may need to be considered for CD.