RESEARCH - Declines in mortality from acute MI in successive incidence and birth cohorts of patients with RA

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(Circulation. 2004;110:1774-1779.)

© 2004 American Heart Association, Inc.

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Coronary Heart Disease

Declines in Mortality From Acute Myocardial Infarction in Successive

Incidence and Birth Cohorts of Patients With Rheumatoid Arthritis

Eswar Krishnan, MD, MPhil; Vijaya Bharathi Lingala, PhD; Gurkirpal Singh, MD

From Stanford University, Division of Immunology (E.K., V.B.L.), and the

Divisions of Gastroenterology and Hepatology (G.S.), Department of Medicine,

1000 Welch Rd, Suite 203, Palo Alto, Calif.

Abstract

Background- Patients with rheumatoid arthritis are at high risk for acute

myocardial infarction (AMI). The treatment of rheumatoid arthritis has

become more intensive over the past 2 decades, resulting in tighter control

of inflammation and lower levels of disability. The impact of this on

atherosclerotic cardiovascular diseases is not known.

Methods and Results- Death rates from AMI in a cohort of 3862 patients with

rheumatoid arthritis followed up from 1980 to 1997 were studied. Time trends

in AMI mortality among successive incidence and birth cohorts were examined

by use of multivariable Poisson regression models and by comparing

standardized mortality ratios. The mean age was 56 years in this

predominantly female cohort (76%), and median disease duration was 6.5

years. During the period of observation, the use of methotrexate increased

substantially, whereas that of prednisone was relatively stable. Over the 22

209 person-years of observation, there were 157 deaths as a result of AMI,

with a death rate of 7.06 per 1000 person-years. Mortality rates were higher

in older age groups and in men. After adjustment for age, sex, race, and

disease duration, the risk of AMI declined in successive incidence years

(relative risk, 0.94; 95% CI, 0.92 to 0.96). Patients with rheumatoid

arthritis incident after 1990 did not have excess AMI mortality compared

with general population. Declines in mortality trends were observed in

successive birth cohorts as well.

Conclusions- Mortality as a result of AMI among patients with rheumatoid

arthritis has declined over time.

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http://circ.ahajournals.org/cgi/content/full/110/13/1774

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