REVIEW - Trends in cardiovascular mortality in patients with RA over 50 years

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Rheumatology Advance Access originally published online on August 20, 2009

Rheumatology 2009 48(10):1309-1313; doi:10.1093/rheumatology/kep252

Trends in cardiovascular mortality in patients with rheumatoid

arthritis over 50 years: a systematic review and meta-analysis of

cohort studies

Christophe Meune1, Emmanuel Touzé2, Ludovic Trinquart3 and Yannick Allanore4

1Department of Cardiology, Cochin Hospital, 2Department of Neurology,

Sainte Anne Hospital, INSERM U894, 3Clinical Research Unit, s

Pompidou European Hospital, and INSERM CIE 4 and 4Department of

Rheumatology A, Cochin Hospital, Université Paris Descartes,

Assistance Publique – Hôpitaux de Paris, Paris, France.

Abstract

Objectives. RA is known to be associated with a high cardiovascular

(CV) risk. Longitudinal data suggest that RA disease course may have

become milder over the past decades. Thus, we set out to estimate the

magnitude of the overall increase in CV mortality associated with RA

and to determine whether it has decreased over the past 50 years.

Methods. We performed a systematic review and a meta-analysis of

literature in MEDLINE and EMBASE databases from January 1960 to

November 2008. All cohort studies reporting CV mortality risk were

included. We then calculated pooled standardized mortality ratios

(SMRs) of CV mortality, and determined their evolution with time using

meta-regression analysis.

Results. Seventeen studies were analysed, corresponding to a total of

91 916 patients. The overall pooled SMR was 1.6 (95% CI 1.5, 1.8; I 2

= 93%; P(het) < 0.0001). Mid-cohort year ranged from 1945 to 1995

(<1980, seven studies; 1980–90, five studies; >1990, five studies).

Meta-regression analyses revealed neither any trend in SMR over time

(P = 0.784) nor any relation with disease duration at the time of

inclusion (P = 0.513).

Conclusions. Our results show that RA is associated with a 60%

increase in risk of CV death compared with general population. Despite

changes in RA course over the past decades, SMR for CV death has not

changed. This suggests that targeting a reduction in CV mortality

should still be considered as a major issue in RA.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/48/10/1309?etoc

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