RESEARCH - Cardiovascular death in RA: A population-based study

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Arthritis Rheum. 2005 Mar;52(3):722-32.

Cardiovascular death in rheumatoid arthritis: A population-based study.

Maradit-Kremers H, Nicola PJ, Crowson CS, Ballman KV, SE.

Mayo Clinic, Rochester, Minnesota.

OBJECTIVE: To determine whether systemic inflammation confers any additional

risk for cardiovascular death among patients with rheumatoid arthritis (RA),

after adjusting for traditional cardiovascular risk factors and

comorbidities. METHODS: Using the population-based data resources of the

Rochester Epidemiology Project, we assembled an incidence cohort of all

Rochester, Minnesota residents ages >/=18 years who first fulfilled the

American College of Rheumatology 1987 criteria for RA between January 1,

1955 and January 1, 1995. All subjects were followed up longitudinally

through their complete (inpatient, outpatient) medical records, beginning at

age 18 years and continuing until death, migration, or January 1, 2001.

Detailed information on the occurrence of various cardiovascular risk

factors (personal history of coronary heart disease [CHD], congestive heart

failure, smoking, hypertension, dyslipidemia, body mass index [bMI],

diabetes mellitus, menopausal status) as well as indicators of systemic

inflammation and RA disease severity (rheumatoid factor [RF] seropositivity,

erythrocyte sedimentation rate [ESR], joint swelling, radiographic changes,

RA nodules, RA complications, RA treatments, disease duration) and

comorbidities were collected on all subjects. Causes of death were

ascertained from death certificates and medical records. regression

models were used to estimate the independent predictors of cardiovascular

death. RESULTS: This inception cohort comprised a total of 603 RA patients

whose mean age was 58 years, of whom 73% were women. During a mean followup

of 15 years, 354 patients died and cardiovascular disease was the primary

cause of death in 176 patients. Personal history of CHD, smoking,

hypertension, low BMI, and diabetes mellitus, as well as comorbidities,

including peripheral vascular disease, cerebrovascular disease, chronic

pulmonary disease, dementia, ulcers, malignancies, renal disease, liver

disease, and history of alcoholism, were all significant risk factors for

cardiovascular death (P < 0.01 for each). Multivariable regression

analyses, controlled for cardiovascular risk factors and comorbidities,

revealed that the risk of cardiovascular death was significantly higher

among RA patients with at least 3 ESR values of >/=60 mm/hour (hazard ratio

---

2.03, 95% confidence interval [95% CI] 1.45-2.83), RA vasculitis (HR

2.41, 95% CI 1.00-5.81), and RA lung disease (HR 2.32, 95% CI 1.11-4.84).

CONCLUSION: These results indicate that markers of systemic inflammation

confer a statistically significant additional risk for cardiovascular death

among patients with RA, even after controlling for traditional

cardiovascular risk factors and comorbidities.

PMID: 15751097

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5751097 & dopt=Abstract

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Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org