A large study of 13,905 patients with inflammatory arthritis found that those with impaired fasting glucose or who used sulfonylureas may have had a higher risk of major adverse cardiovascular events.
The study, conducted in Hong Kong, included patients diagnosed with either rheumatoid arthritis or psoriatic arthritis from 2006 to 2018. Using hospital records, investigators tracked the development of major adverse cardiovascular events (MACE), including heart attacks, strokes, and cardiovascular-related mortality. During follow-up, 6.7% (n = 934) of the patients experienced a cardiovascular event.
Among the patients who were not taking diabetes medication, those who had impaired fasting glucose (IFG) levels—defined as fasting glucose between 5.6 and 6.9 mmol/L—were more than twice as likely to experience a MACE compared with those with normal blood sugar levels. The patients with fasting glucose of 7 mmol/L or higher had over three times the risk.
In patients with diabetes, the type of glucose-lowering medication used was also significant. Those taking sulfonylureas had a 50% to 55% higher risk of cardiovascular issues compared with nonusers, even after adjusting for age, sex, inflammation, and other health factors. Insulin users had more than three times the risk, although these patients also tended to have more complex health profiles. Metformin users had a lower unadjusted risk of MACE, but this association was not statistically significant after adjustment.
“Our results highlight the exaggerated cardiovascular risk of prediabetes in the background of systemic inflammatory disease, and early blood glucose control may play a crucial role in the prevention of [cardiovascular disease] among patients with [inflammatory arthritis],” said lead study author Huan Meng, of The Chinese University of Hong Kong, and colleagues.
The study was among the first large-scale studies to examine both blood sugar status and diabetes medication in patients with inflammatory arthritis. The findings supported the need for proactive glucose monitoring and careful selection of antidiabetic treatments in this patient population.
The investigators noted several limitations. The study lacked data on lifestyle risk factors such as smoking and obesity, and the majority of participants were East Asian, which may limit generalizability. Additionally, the newer classes of diabetes drugs, such as glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors, were underrepresented and couldn't be adequately evaluated.
Despite these limitations, the study added important evidence that even mildly elevated blood sugar could increase cardiovascular risks in patients with inflammatory arthritis. The use of certain diabetes medications may further contribute to cardiovascular risk.
The investigators suggested that physicians managing rheumatoid arthritis and psoriatic arthritis should assess cardiovascular risk not only through traditional markers but also by monitoring glucose levels and considering the cardiovascular profiles of diabetes treatments.
The authors declare no competing interests.
Source: Diabetology & Metabolic Syndrome
