RESEARCH - Patterns of cardiovascular risk in RA

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Published Online First: 22 June 2006. doi:10.1136/ard.2005.050377

ls of the Rheumatic Diseases 2006;65:1608-1612

© 2006 by BMJ Publishing Group Ltd & European League Against Rheumatism

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EXTENDED REPORT

Patterns of cardiovascular risk in rheumatoid arthritis

D H , N J Goodson, J N Katz, M E Weinblatt, J Avorn, S Setoguchi, C

Canning and S Schneeweiss

Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston,

Massachussetts, USA

Correspondence to:

D H

Division of Pharmacoepidemiology, Brigham and Women's Hospital, 1620 Tremont

Street, Suite 3030, Boston, MA 02120, USA; dhsolomon@...

Background: Although it is known that rheumatoid arthritis is associated

with an increased risk of cardiovascular disease (CVD), the pattern of this

risk is not clear. This study investigated the relative risk of myocardial

infarction, stroke and CVD mortality in adults with rheumatoid arthritis

compared with adults without rheumatoid arthritis across age groups, sex and

prior CVD event status.

Methods: We conducted a cohort study among all residents aged 18 years

residing in British Columbia between 1999 and 2003. Residents who had

visited the doctor at least thrice for rheumatoid arthritis (International

Classification of Disease = 714) were considered to have rheumatoid

arthritis. A non-rheumatoid arthritis cohort was matched to the rheumatoid

arthritis cohort by age, sex and start of follow-up. The primary composite

end point was a hospital admission for myocardial infarction, stroke or CVD

mortality.

Results: 25 385 adults who had at least three diagnoses for rheumatoid

arthritis during the study period were identified. During the 5-year study

period, 375 patients with rheumatoid arthritis had a hospital admission for

myocardial infarction, 363 had a hospitalisation for stroke, 437 died from

cardiovascular causes and 1042 had one of these outcomes. The rate ratio for

a CVD event in patients with rheumatoid arthritis was 1.6 (95% confidence

interval (CI) 1.5 to 1.7), and the rate difference was 5.7 (95% CI 4.9 to

6.4) per 1000 person-years. The rate ratio decreased with age, from 3.3 in

patients aged 18-39 years to 1.6 in those aged 75 years. However, the rate

difference was 1.2 per 1000 person-years in the youngest age group and

increased to 19.7 per 1000 person-years in those aged 75 years. Among

patients with a prior CVD event, the rate ratios and rate differences were

not increased in rheumatoid arthritis.

Conclusions: This study confirms that rheumatoid arthritis is a risk factor

for CVD events and shows that the rate ratio for CVD events among subjects

with rheumatoid arthritis is highest in young adults and those without known

prior CVD events. However, in absolute terms, the difference in event rates

is highest in older adults.

http://ard.bmj.com/cgi/content/abstract/65/12/1608

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