RESEARCH - Contribution of congestive heart failure and ischemic heart disease to excess mortality in RA

[Guest guest]

Arthritis Rheum. 2006 Jan;54(1):60-7.

Contribution of congestive heart failure and ischemic heart disease to

excess mortality in rheumatoid arthritis.

Nicola PJ, Crowson CS, Maradit-Kremers H, Ballman KV, VL, sen SJ,

SE.

Dept. of Health Sciences Research, Mayo Clinic College of Medicine, 200

First Street SW, Rochester, MN 55905, USA.

OBJECTIVE: Although mortality among patients with rheumatoid arthritis (RA)

is higher than in the general population, the relative contribution of

comorbid diseases to this mortality difference is not known. This study was

undertaken to evaluate the contribution of congestive heart failure (CHF)

and ischemic heart disease (IHD), including myocardial infarction, to the

excess mortality in patients with RA, compared with that in individuals

without RA. METHODS: We assembled a population-based inception cohort of

individuals living in Rochester, Minnesota, in whom RA (defined according to

the criteria of the American College of Rheumatology [formerly, the American

Rheumatism Association]) first developed between 1955 and 1995, and an age-

and sex-matched non-RA cohort. All subjects were followed up until either

death, migration from the county, or until 2001. Detailed information from

the complete medical records was collected. Statistical analyses included

the person-years method, cumulative incidence, and regression modeling.

Attributable risk analysis techniques were used to estimate the number of RA

deaths that would be prevented if the incidence of CHF was the same in

patients with RA and non-RA subjects. RESULTS: The study population included

603 patients with RA and 603 subjects without RA. During followup, there was

an excess of 123 deaths among patients with RA (345 RA deaths occurred,

although only 222 such deaths were expected). The mortality rates among

patients with RA and non-RA subjects were 39.0 and 29.2 per 1,000

person-years, respectively. There was a significantly higher cumulative

incidence of CHF (but not IHD) in patients with RA compared with non-RA

subjects (37.1% versus 27.7% at 30 years of followup, respectively; P <

0.001). The risk of death associated with either CHF or IHD was not

significantly different between patients with RA and non-RA subjects. If the

risk of developing CHF was the same in patients with RA and individuals

without RA, the overall mortality rate difference between RA and non-RA

hypothetically would be reduced from 9.8 to 8.0 excess deaths per 1,000

person-years; that is, 16 (13%) of the 123 excess deaths could be prevented.

CONCLUSION: CHF, rather than IHD, appears to be an important contributor to

the excess overall mortality among patients with RA. CHF contributes to this

excess mortality primarily through the increased incidence of CHF in RA,

rather than increased mortality associated with CHF in patients with RA

compared with non-RA subjects. Eliminating the excess risk of CHF in

patients with RA could significantly improve their survival.

PMID: 16385496

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16385496

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org