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Ferraz-Amaro I, Genre F, Blanco R, Calvo-Rio V, Corrales-Selaya C, Portilla V, Aurrecoechea E, Batanero R, Hernández-Hernández V, Quevedo-Abeledo JC, Rodríguez-Lozano C, López-Medina C, Ladehesa-Pineda L, Castañeda S, Vicente-Rabaneda EF, Fernández-Carballido C, Martínez Vidal MP, Castro Corredor D, Anino Fernández J, Peiteado D, Plasencia-Rodriguez C, Expósito R, Garcia Vivar ML, Galíndez-Agirregoikoa E, Vegas N, Urionagüena I, Montes-Perez E, Gonzalez-Gay MA, Rueda-Gotor J. Sex-specific impact of inflammation on traditional cardiovascular risk factors and atherosclerosis in axial spondyloarthritis. A multicentre study of 913 patients. RMD Open 2024; 10:e004187. [PMID: 38942590 PMCID: PMC11227836 DOI: 10.1136/rmdopen-2024-004187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/18/2024] [Indexed: 06/30/2024] Open
Abstract
INTRODUCTION The nature of the relationship between inflammation, cardiovascular (CV) risk factors and atherosclerosis in axial spondyloarthritis (axSpA) remains largely unknown and sex differences in this regard are yet to be assessed. METHODS Study including 611 men and 302 women from the Spanish multicentre AtheSpAin cohort to assess CV disease in axSpA. Data on CV disease risk factors were collected both at disease diagnosis and at enrolment, and data on disease activity, functional indices and carotid ultrasonography only at enrolment. RESULTS After a median disease duration of 9 years, patients of both sexes who at disease diagnosis had elevated acute phase reactants (APRs), more frequently had hypertension and obesity. The same occurred with dyslipidaemia in men and with diabetes mellitus in women. At enrolment, CV risk factors were independently associated with APR and with activity and functional indices, with various sex differences. C reactive protein (CRP) values were inversely associated with HDL-cholesterol in men (β coefficient: -1.2 (95% CI: -0.3 to -0.07) mg/dL, p=0.001), while erythrocyte sedimentation rate values were positively associated with triglycerides in women (β coefficient: 0.6 (95% CI: 0.04 to 1) mg/dL, p=0.035). Furthermore, only women showed an independent relationship between insulin resistance parameters and APR or disease activity. Both men and women with high-very high CV risk according to the Systematic Assessment of Coronary Risk Evaluation 2 and CRP levels higher than 3 mg/L at diagnosis of the disease presented carotid plaques significantly more frequently than those with normal CRP levels at disease diagnosis. CONCLUSION Inflammation is associated with atherosclerosis and CV disease in axSpA. A gender-driven effect is observed in this relationship.
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Affiliation(s)
- Ivan Ferraz-Amaro
- Servicio de Reumatologia, Hospital Universitario de Canarias, La Laguna, Spain
| | - Fernanda Genre
- Grupo Inmunopatología, Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Ricardo Blanco
- Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Vanesa Calvo-Rio
- Grupo Inmunopatología, Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Reumatologia, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Cristina Corrales-Selaya
- Grupo Inmunopatología, Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Hospital Universitario Marqués de Valdecilla, Servicio de Reumatología, Santander, Spain
| | | | | | - Ricardo Batanero
- Endocrino, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | | | | | - Carlos Rodríguez-Lozano
- Rheumatology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Clementina López-Medina
- Rheumatology, Reina Sofia University Hospital, Cordoba, Spain
- GC05, Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
| | | | - Santos Castañeda
- Rheumatology Department, Hospital Universitario La Princesa, Madrid, Spain
- Rheumatology, FJD, Madrid, Spain
| | | | | | | | - David Castro Corredor
- Servicio de Reumatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | | | - Maria Luz Garcia Vivar
- Department of Rheumatology, Osakidetza Basque Health Service, Basurto University Hospital, Barcelona, Spain
| | | | - Nuria Vegas
- Reumatologia, Hospital de Galdakao-Usansolo, Galdakao, Spain
| | - Irati Urionagüena
- Rheumatology Division, Hospital Universitario Cruces, Barakaldo, Spain
| | | | - Miguel A Gonzalez-Gay
- Rheumatology, ISS Fundacion Jimenez Diaz, Madrid, Spain
- Department of Medicine and Psychiatry, Medicine, University of Cantabria, Santander, Spain
| | - Javier Rueda-Gotor
- Grupo Inmunopatología, Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Reumatologia, Hospital Sierrallana y Tres Mares, Torrelavega, Spain
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Carrillo-Palau M, Hernández-Camba A, Hernández Alvarez-Buylla N, Ramos L, Alonso-Abreu I, Hernández-Pérez A, Vela M, Arranz L, Hernández-Guerra M, González-Gay MÁ, Ferraz-Amaro I. Insulin Resistance Is Not Increased in Inflammatory Bowel Disease Patients but Is Related to Non-Alcoholic Fatty Liver Disease. J Clin Med 2021; 10:jcm10143062. [PMID: 34300227 PMCID: PMC8304915 DOI: 10.3390/jcm10143062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Insulin resistance (IR) has been linked to inflammatory states. The aim of this study was to determine whether IR is increased in a cohort of inflammatory bowel disease (IBD) patients with low disease activity. We additionally intended to establish which factors were the determinants of IR in this population, including the presence of nonalcoholic fatty liver disease (NAFLD). METHODS Cross-sectional study encompassing 151 IBD patients and 174 non-diabetic controls. Insulin and C-peptide serum levels and IR and beta cell function (%B) indices based on homoeostatic model assessment (HOMA2) were assessed in patients and controls. Liver stiffness as measured by transient elastography, and the presence of NAFLD detected via ultrasound were additionally assessed. A multivariable regression analysis was performed to evaluate the differences in IR indexes between patients and controls, and to determine which predictor factors were associated with IR in IBD patients. RESULTS Neither HOMA2-IR (beta coef. -0.26 {95%CI -0.64-0.13}, p = 0.19) nor HOMA2-%B (beta coef. 15 {95%CI -14-44}, p = 0.31) indexes differed between patients and controls after fully multivariable analysis. Among classic IR risk factors, obesity, abdominal circumference, and triglycerides significantly and positively correlated with IR indexes in IBD patients. However, most features related to IBD, such as disease patterns, disease activity, and inflammatory markers, were not associated with IR. The presence of NAFLD was independently and significantly associated with beta cell dysfunction in patients with IBD (HOMA2-B grade 4, 251 ± 40 vs. grade 1, 107 ± 37, p = <0.001). CONCLUSIONS IR is not increased in IBD patients with low disease activity compared to controls. However, the presence of NAFLD favors the development of IR in patients with IBD.
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Affiliation(s)
- Marta Carrillo-Palau
- Division of Gastroenterology, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (M.C.-P.); (N.H.A.-B.); (L.R.); (I.A.-A.); (A.H.-P.); (M.H.-G.)
| | - Alejandro Hernández-Camba
- Division of Gastroenterology, Hospital Universitario de Nuestra Señora de la Candelaria, 38010 Tenerife, Spain; (A.H.-C.); (M.V.); (L.A.)
| | - Noemi Hernández Alvarez-Buylla
- Division of Gastroenterology, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (M.C.-P.); (N.H.A.-B.); (L.R.); (I.A.-A.); (A.H.-P.); (M.H.-G.)
| | - Laura Ramos
- Division of Gastroenterology, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (M.C.-P.); (N.H.A.-B.); (L.R.); (I.A.-A.); (A.H.-P.); (M.H.-G.)
| | - Inmaculada Alonso-Abreu
- Division of Gastroenterology, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (M.C.-P.); (N.H.A.-B.); (L.R.); (I.A.-A.); (A.H.-P.); (M.H.-G.)
| | - Anjara Hernández-Pérez
- Division of Gastroenterology, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (M.C.-P.); (N.H.A.-B.); (L.R.); (I.A.-A.); (A.H.-P.); (M.H.-G.)
| | - Milagros Vela
- Division of Gastroenterology, Hospital Universitario de Nuestra Señora de la Candelaria, 38010 Tenerife, Spain; (A.H.-C.); (M.V.); (L.A.)
| | - Laura Arranz
- Division of Gastroenterology, Hospital Universitario de Nuestra Señora de la Candelaria, 38010 Tenerife, Spain; (A.H.-C.); (M.V.); (L.A.)
| | - Manuel Hernández-Guerra
- Division of Gastroenterology, Hospital Universitario de Canarias, 38320 Tenerife, Spain; (M.C.-P.); (N.H.A.-B.); (L.R.); (I.A.-A.); (A.H.-P.); (M.H.-G.)
| | - Miguel Á. González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, 39008 Santander, Spain;
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39008 Santander, Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, 38320 Tenerife, Spain
- Correspondence:
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