RESEARCH - Risk of cardiovascular mortality in patients with RA: a meta-analysis of observational studies

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Arthritis Rheum. 2008 Nov 26;59(12):1690-1697.

Risk of cardiovascular mortality in patients with rheumatoid

arthritis: A meta-analysis of observational studies.

Aviña-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D.

University of British Columbia and Arthritis Research Centre of

Canada, Vancouver, British Columbia, Canada.

OBJECTIVE: To determine the magnitude of risk of cardiovascular

mortality in patients with rheumatoid arthritis (RA) compared with the

general population through a meta-analysis of observational studies.

METHODS: We searched Medline, EMBase, and Lilacs databases from their

inception to July 2005. Observational studies that met the following

criteria were assessed by 2 researchers: 1) prespecified RA

definition, 2) clearly defined cardiovascular disease (CVD) outcome,

including ischemic heart disease (IHD) and cerebrovascular accidents

(CVAs), and 3) reported standardized mortality ratios (SMRs) and 95%

confidence intervals (95% CIs). We calculated weighted-pooled summary

estimates of SMRs (meta-SMRs) for CVD, IHD, and CVAs using the

random-effects model, and tested for heterogeneity using the I(2)

statistic.

RESULTS: Twenty-four studies met the inclusion criteria, comprising

111,758 patients with 22,927 cardiovascular events. Overall, there was

a 50% increased risk of CVD death in patients with RA (meta-SMR 1.50,

95% CI 1.39-1.61). Mortality risks for IHD and CVA were increased by

59% and 52%, respectively (meta-SMR 1.59, 95% CI 1.46-1.73 and

meta-SMR 1.52, 95% CI 1.40-1.67, respectively). We identified

asymmetry in the funnel plot (Egger's test P = 0.002), as well as

significant heterogeneity in all main analyses (P < 0.0001). Subgroup

analyses showed that inception cohort studies (n = 4, comprising 2,175

RA cases) were the only group that did not show a significantly

increased risk for CVD (meta-SMR 1.19, 95% CI 0.86-1.68).

CONCLUSION: Published data indicate that CVD mortality is increased by

approximately 50% in RA patients compared with the general population.

However, we found that study characteristics may influence the

estimate.

PMID: 19035419

http://www.ncbi.nlm.nih.gov/pubmed/19035419

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