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Background Increased cardiovascular risk has been suggested for selected autoimmune disorders. Yet, for many conditions, evidence is insufficient to design more targeted prevention measures and guide clinical decisions. Methods We used linked primary and secondary electronic health records from the Clinical Practice Research Datalink (CPRD) to assemble a cohort of individuals newly diagnosed with any of 19 autoimmune disorders between 01/01/2000 and 31/12/2017 and free of cardiovascular disorders (CVD) up to 12 months after diagnosis, and up to five individuals matched on age, sex and socioeconomic status, with follow-up until 30/06/2019. We investigated incidence of nine cardiovascular outcomes and used cox-proportional hazards models to examine differences in patients with and without autoimmune disorders accounting for known cardiovascular risk factors. Findings We identified 432,883 individuals with autoimmune disorders and 2,159,350 matched controls. Of these, 104,504 people with and 450,195 without autoimmune disorders developed incident CVD during a median of 5.3 [interquartile range: 2.6, 9.6] years of follow-up. Patients with one or more autoimmune disorders had higher risk of cardiovascular outcomes: adjusted hazard ratio (HR) [95% confidence interval (CI)] 1.34 [1.31, 1.37]. This relationship held for every individual cardiovascular disorder and increased progressively with the number of autoimmune disorders present. Among autoimmune disorders, those associated with systemic inflammation, such as type I diabetes (2.09 [1.91, 2.28]), systemic sclerosis (2.90 [2.29, 3.67]) and systemic lupus erythematosus (2.21 [1.96, 2.50]) presented with highest overall cardiovascular risk (Figure). Interpretation Autoimmune disorders are associated with a high risk of developing cardiovascular outcomes. These findings warrant targeted cardiovascular prevention measures for patients with autoimmune disorders and further research into pathophysiological mechanisms underlying these complications. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie (grant agreement No 843267) and from the European Society of Cardiology (grant number App000037070).

ObjectivesTo describe the sonographic features of endometrial cancer in relation to stage, grade, and histological type using the International Endometrial Tumor Analysis (IETA) terminology. MethodsProspective multicenter study on 1714 women with endometrial cancer undergoing a standardized transvaginal grayscale and Doppler ultrasound examination by an experienced ultrasound examiner using a high-end ultrasound system. Clinical and sonographic data were entered into a web-based protocol. We assessed how strongly sonographic characteristics, according to IETA, were associated to outcome at hysterectomy, i.e. tumor stage, grade, and histological type. ResultsAfter excluding 176 women (no or delayed hysterectomy, final diagnosis other than endometrial cancer, or incomplete data), 1538 women were included in our statistical analysis. Median age was 65 years (range 27–98), and median BMI 28.4 (range 16–67), 1378 (89.7%) women were postmenopausal, and 1296 (84.2%) reported abnormal vaginal bleeding. Grayscale and color Doppler features varied according to grade and stage. High-risk tumors (stage 1A, grade 3 or non-endometrioid or ≥ stage 1B) were less likely to have regular endometrial myometrial border (difference of −23%, 95% CI −27 to −18%), whilst they were larger (mean endometrial thickness; difference of +9 mm, 95% CI +8 to +11 mm), more frequently had non-uniform echogenicity (difference of +10%, 95% CI +5 to +15%), a multiple, multifocal vessel pattern (difference of +21%, 95% CI +16 to +26%), and a moderate or high color score (difference of +22%, 95% CI +18 to +27%), than low-risk tumors. ConclusionGrayscale and color Doppler ultrasound features are associated with grade and stage, and differ between high and low risk endometrial cancer.