RESEARCH - The risk of myocardial infarction and pharmacologic and nonpharmacologic MI predictors in RA

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Arthritis Rheum. 2008 Sep;58(9):2612-21.

The risk of myocardial infarction and pharmacologic and

nonpharmacologic myocardial infarction predictors in rheumatoid

arthritis: A cohort and nested case-control analysis.

Wolfe F, Michaud K.

National Data Bank for Rheumatic Diseases, Wichita, Kansas, and

University of Kansas School of Medicine, Wichita.

OBJECTIVE: To determine the risk of myocardial infarction (MI) in

patients with rheumatoid arthritis (RA) compared with that in patients

with noninflammatory rheumatic disorders and to determine risk factors

for MI in RA, the relationship between cardiovascular risk factors and

corticosteroid use, and the relationship between RA treatment and MI.

METHODS: We conducted a cohort study of MI in 17,738 patients with RA

and 3,001 patients with noninflammatory rheumatic disorders who were

assessed at 6-month intervals between 1999 and July 2006. We evaluated

treatment effect in a nested case-control study of RA participants who

were matched by age, sex, study duration, and date of study entry.

RESULTS: The covariate-adjusted risk of first MI in RA versus that in

noninflammatory rheumatic disorders was 1.9 (95% confidence interval

1.2-2.9) (P = 0.005). In RA, MI was predicted by age, sex, education

level, hypertension, smoking, exercise, prior MI, diabetes, a

comorbidity index, use of low-dose aspirin and antilipemic agents, RA

severity and treatment variables, and corticosteroid use. Except for

obesity, predictors were of equal strength in RA and noninflammatory

rheumatic disorders. The increased risk for MI in RA compared with

that in noninflammatory rheumatic disorders lessened when

corticosteroid users were excluded. Use of corticosteroids was

associated with future development of diabetes and hypertension.

CONCLUSION: MI in RA is associated with demographic and cardiovascular

risk factors and corticosteroid use. Study data support the hypothesis

that RA activity causes MI and that corticosteroids are primarily a

marker of RA activity. However, corticosteroids increase the risk of

diabetes and hypertension and contribute to the overall risk of MI.

PMID: 18759273

http://www.ncbi.nlm.nih.gov/pubmed/18759273

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