How much of the increased incidence of heart failure in rheumatoid arthritis is attributable to traditional cardiovascular risk factors and ischemic heart disease?
How much of the increased incidence of heart failure in rheumatoid arthritis is attributable to traditional cardiovascular risk factors and ischemic heart disease?
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DOI：
10.1002/art.21349
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发表时间：
2005-10-01
影响因子：
--
通讯作者：
Gabriel, SE
中科院分区：
文献类型：
--
作者：
Crowson, CS;Nicola, PJ;Gabriel, SE
目的：比较类风湿关节炎（RA）患者和非RA患者中可归因于传统心血管（CV）危险因素、缺血性心脏病（IHD）和酗酒的心力衰竭（HF）发生风险比例。
方法：组建一个基于人群的RA患者起始队列以及一个类似的非RA受试者队列。通过完整的医疗记录对所有个体进行随访，直至发生HF、死亡、迁移或到2001年1月1日。HF的归因风险估计为每个队列中观察到的HF累积发病率（通过多变量Cox模型估计并针对死亡的竞争风险进行调整）与无危险因素时预测的HF累积发病率之间的差值，结果以观察到的累积发病率的百分比表示。
结果：在发病/索引日期时无HF的共575名RA受试者和583名非RA受试者（平均年龄57岁，73%为女性）的平均随访时间分别为15.1年和17.0年。在此期间，165名RA受试者和115名非RA受试者首次发生HF，80岁时的累积发病率分别为36.3%和20.4%。在非RA受试者中，80岁时77%的HF可归因于CV危险因素、IHD和酗酒的综合作用，而在RA受试者中，80岁时只有54%的HF可归因于这些因素（P < 0.01）。
结论：RA患者中HF的额外风险不能用CV危险因素和IHD的频率增加或作用增强来解释。
Objective. To compare the proportion of the risk for the development of heart failure (HF) that is attributable to traditional cardiovascular (CV) risk factors, ischemic heart disease (IHD), and alcohol abuse between subjects with and subjects without rheumatoid arthritis (RA).Methods. A population-based inception cohort of RA patients was assembled along with a similar cohort of subjects without RA. All individuals were followed up through their complete medical records, until HF incidence, death, migration, or January 1, 2001. The attributable risk of HIT was estimated as the difference between the observed cumulative incidence of HF in each cohort (estimated from multivariable Cox models and adjusted for the competing risk of death) and the predicted cumulative incidence of HF in the absence of risk factors, with results expressed as a percentage of the observed cumulative incidence.Results. A total of 575 RA subjects and 583 non-RA subjects (mean age 57 years, 73% women) without HIT at incidence/index date had a mean followup of 15.1 and 17.0 years, respectively. During that period, 165 RA and 115 non-RA subjects had a first episode of HF, with a cumulative incidence of 36.3% and 20.4%, respectively, at age 80 years. Among non-RA subjects, 77% of the HF at age 80 years was attributable to CV risk factors, IHD, and alcohol abuse combined, whereas among RA subjects, only 54% of the HF at age 80 years was attributable to these factors (P < 0.01).Conclusion. The excess risk of HF among RA patients is not explained by an increased frequency or effect of CV risk factors and lHD.