title: Risk of subsequent coronary heart disease in patients hospitalized for immune-mediated diseases: a nationwide follow-up study from Sweden.
abstract: BACKGROUND
  Certain immune-mediated diseases (IMDs), such as rheumatoid arthritis and systemic lupus erythematosus, have been linked to cardiovascular disorders. We examined whether there is an association between 32 different IMDs and risk of subsequent hospitalization for coronary heart disease (CHD) related to coronary atherosclerosis in a nationwide follow up study in Sweden.
  
  
  RESULTS
  All individuals in Sweden hospitalized with a main diagnosis of an IMD (n = 336,479) without previous or coexisting CHD, between January 1, 1964 and December 31 2008, were followed for first hospitalization for CHD. The reference population was the total population of Sweden. Standardized incidence ratios (SIRs) for CHD were calculated. Overall risk of CHD during the first year after hospitalization for an IMD was 2.92 (95% CI 2.84-2.99). Twenty-seven of the 32 IMDs studied were associated with an increased risk of CHD during the first year after hospitalization. The overall risk of CHD decreased over time, from 1.75 after 1-5 years (95% CI 1.73-1.78), to 1.43 after 5-10 years (95% CI 1.41-1.46) and 1.28 after 10+ years (95% CI 1.26-1.30). Females generally had higher SIRs than males. The IMDs for which the SIRs of CDH were highest during the first year after hospitalization included chorea minor 6.98 (95% CI 1.32-20.65), systemic lupus erythematosus 4.94 (95% CI 4.15-5.83), rheumatic fever 4.65 (95% CI 3.53-6.01), Hashimoto's thyroiditis 4.30 (95% CI 3.87-4.75), polymyositis/dermatomyositis 3.81 (95% CI 2.62-5.35), polyarteritis nodosa 3.81 (95% CI 2.72-5.19), rheumatoid arthritis 3.72 (95% CI 3.56-3.88), systemic sclerosis 3.44 (95% CI 2.86-4.09), primary biliary cirrhosis 3.32 (95% CI 2.34-4.58), and autoimmune hemolytic anemia 3.17 (95% CI 2.16-4.47).
  
  
  CONCLUSIONS
  Most IMDs are associated with increased risk of CHD in the first year after hospital admission. Our findings suggest that many hospitalized IMDs are tightly linked to coronary atherosclerosis.
authors.affiliation: Center for Primary Health Care Research, Lund University/Region Skåne, Clinical Research Centre, Skåne University Hospital, Malmö, Sweden. bengt.zoller@med.lu.se
authors.forename: Bengt
authors.initials: B
authors.lastname: Zöller
authors.forename: Xinjun
authors.initials: X
authors.lastname: Li
authors.forename: Jan
authors.initials: J
authors.lastname: Sundquist
authors.forename: Kristina
authors.initials: K
authors.lastname: Sundquist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications; D001172:Arthritis, Rheumatoid / Q000150:complications; D002819:Chorea / Q000150:complications; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D003882:Dermatomyositis / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D050031:Hashimoto Disease / Q000150:complications; D006760:Hospitalization; D006801:Humans; D007154:Immune System Diseases / Q000150:complications* / Q000276:immunology; D015994:Incidence; D008105:Liver Cirrhosis, Biliary / Q000150:complications; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008297:Male; D008875:Middle Aged; D018448:Models, Immunological; D010488:Polyarteritis Nodosa / Q000150:complications; D012213:Rheumatic Fever / Q000150:complications; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications; D013548:Sweden / Q000453:epidemiology