RESEARCH - Cardiovascular admissions and mortality of patients with RA with an onset in the 1980's and 1990's.

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Ann Rheum Dis. 2005 Apr 20; [Epub ahead of print]

Cardiovascular admissions and mortality in an inception cohort of patients

with rheumatoid arthritis with an onset in the 1980's and 1990's.

Goodson NJ, Marks J, Lunt M, Symmons DP.

Liverpool University, United Kingdom.

BACKGROUND: Rheumatoid arthritis (RA) patients have increased cardiovascular

disease (CVD) mortality. However, studies have suggested RA survival may

have improved over recent decades. Excess CVD mortality may be due to an

increased prevalence of CVD or to an increased case fatality in RA patients.

OBJECTIVES: To examine whether RA patients with disease onset in the

1980s-1990s have increased mortality rates and to compare cardiovascular

admission rates in RA patients with those of the general population.

METHODS: An inception cohort of 1010 RA patients attending Stockport

rheumatology clinics between 1981 and 1996 was followed up to 31st December

2002 via the Office for National Statistics (ONS). Standardised mortality

ratios (SMR) were calculated for all cause and cause specific mortality

using the population of Stockport as the reference. CVD admission rates were

ascertained for a subgroup of these patients, using national hospital

episode statistics, and standardised CVD admission rates (SAR) and SMRs were

calculated for this subgroup. RESULTS: 470 (48%) patients died during a

median follow-up period of 11.4 years. All cause mortality was increased in

men: (SMR 1.45 (95% 1.22, 1.71)); and women: (SMR1.84; (95% CI 1,64, 2.05)),

as was CVD mortality, men: (SMR 1.36 (95% CI 1.04, 1.75); and women: (SMR

1.93 (95%CI 1.65, 2.26)). No difference in CVD admission rates was observed

in men: (SAR 1.20 (95% CI 0.89, 1.58); or women: (SAR 1.10 (95% CI 0.88,

1.36)) despite excess CVD mortality in this subgroup.

CONCLUSION: RA patients still experience reduced life expectancy and excess

CVD mortality. Despite this, standardised admission rates for CVD were not

raised. This suggests either that CVD in RA has a higher case fatality than

the general population or that it is frequently unrecognised in RA patients

prior to the fatal event.

PMID: 15843450

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

5843450 & dopt=Abstract

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