title: Chronic inflammatory disorders and risk of type 2 diabetes mellitus, coronary heart disease, and stroke: a population-based cohort study.
abstract: BACKGROUND
  This study sought to evaluate whether risks of diabetes mellitus and cardiovascular disease are elevated across a range of organ-specific and multisystem chronic inflammatory disorders.
  
  
  RESULTS
  A matched cohort study was implemented in the UK Clinical Practice Research Datalink including participants with severe psoriasis (5648), mild psoriasis (85 232), bullous skin diseases (4284), ulcerative colitis (12 203), Crohn's disease (7628), inflammatory arthritis (27 358), systemic autoimmune disorders (7472), and systemic vasculitis (6283) and in 373 851 matched controls. The main outcome measures were new diagnoses of type 2 diabetes mellitus, stroke, or coronary heart disease. The outcomes were evaluated for each condition in a multiple outcomes model, with adjustment for conventional cardiovascular risk factors. Estimates for different inflammatory conditions were pooled in a random-effects meta-analysis. There were 4695 new diagnoses of type 2 diabetes mellitus, 3266 of coronary heart disease, and 1715 of stroke. The hazard ratio for pooled multiple failure estimate was 1.20 (95% confidence interval [CI], 1.15-1.26). The highest relative hazards were observed in systemic autoimmune disorders (1.32; 95% CI, 1.16-1.50) and systemic vasculitis (1.29; 95% CI, 1.16-1.44). Hazards were increased in organ-specific disorders, including severe psoriasis (1.29; 95% CI, 1.12-1.47) and ulcerative colitis (1.26; 95% CI, 1.14-1.40). Participants in the highest tertile of C-reactive protein had greater risk of multiple outcomes (1.52; 95% CI, 1.37-1.68).
  
  
  CONCLUSIONS
  The risk of cardiovascular diseases and type 2 diabetes mellitus is increased across a range of organ-specific and multisystem chronic inflammatory disorders with evidence that risk is associated with severity of inflammation. Clinical management of patients with chronic inflammatory disorders should seek to reduce cardiovascular risk.
authors: From the Department of Primary Care and Public Health Sciences (A.D., M.C.G., J.C.), National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust (A.D., M.C.G.), and British Heart Foundation Centre (P.C.), King's College London, London, United Kingdom. alexandru.dregan@kcl.ac.uk.
authors: Alex
authors: A
authors: Dregan
authors: From the Department of Primary Care and Public Health Sciences (A.D., M.C.G., J.C.), National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust (A.D., M.C.G.), and British Heart Foundation Centre (P.C.), King's College London, London, United Kingdom.
authors: Judith
authors: J
authors: Charlton
authors: From the Department of Primary Care and Public Health Sciences (A.D., M.C.G., J.C.), National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust (A.D., M.C.G.), and British Heart Foundation Centre (P.C.), King's College London, London, United Kingdom.
authors: Phil
authors: P
authors: Chowienczyk
authors: From the Department of Primary Care and Public Health Sciences (A.D., M.C.G., J.C.), National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust (A.D., M.C.G.), and British Heart Foundation Centre (P.C.), King's College London, London, United Kingdom.
authors: Martin C
authors: MC
authors: Gulliford
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000097:blood / Q000150:complications; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D002908:Chronic Disease; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000150:complications*; D015212:Inflammatory Bowel Diseases / Q000097:blood / Q000150:complications; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000097:blood / Q000150:complications; D012216:Rheumatic Diseases / Q000097:blood / Q000150:complications; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D006113:United Kingdom
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: biomarker; coronary disease; diabetes mellitus; inflammation; stroke