Decreased Cardiovascular Mortality in Patients with Incident Rheumatoid Arthritis (RA) in Recent Years: Dawn of a New Era in Cardiovascular Disease in RA?
Decreased Cardiovascular Mortality in Patients with Incident Rheumatoid Arthritis (RA) in Recent Years: Dawn of a New Era in Cardiovascular Disease in RA?
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DOI：
10.3899/jrheum.161154
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发表时间：
2017-06-01
影响因子：
3.9
通讯作者：
Crowson, Cynthia S.
中科院分区：
文献类型：
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作者：
Myasoedova, Elena;Gabriel, Sherine E.;Crowson, Cynthia S.
客观的。与非 RA 受试者相比，评估 2000-07 年发生类风湿性关节炎 (RA) 患者的心血管 (CV) 死亡率趋势，与过去几十年相比。方法。研究人群包括美国明尼苏达州奥姆斯特德县患有 RA 的居民（年龄 >= 18 岁，1980-2007 年符合 1987 年美国风湿病学会标准）和来自相同基础人群的具有相似年龄、性别和指数日历年份的非 RA 受试者。对所有受试者进行随访直至死亡、迁移或 2014 年 12 月 31 日。为了可比性，随访时间被缩短。 Aalen-Johansen 方法用于估计心血管死亡率，并调整其他原因的竞争风险。 Cox 比例风险模型用于按十年比较心血管死亡率。结果。该研究包括 813 名 RA 患者和 813 名非 RA 受试者（平均年龄 55.9 岁；两组中 68% 为女性）。 2000-07 年发生 RA 的患者的 10 年总体心血管死亡率（2.7%，95% CI 0.6-4.9%）和冠心病（CHD）死亡率（1.1%，95% CI 0.0-2.7%）显着低于 1990-99 年诊断的患者（7.1%，95% CI 3.9-10.1%，分别为 4.5%、95% CI 1.9-7.1%；总体心血管死亡的 HR：0.43、95% CI 0.19-0.94；CHD 死亡：HR 0.21、95% CI 0.05-0.95。在考虑了心血管风险因素后，心血管死亡率的这种改善仍然存在。 2000-07 年 RA 发病队列的十年总体 CV 死亡率和 CHD 死亡率与非 RA 受试者相似（分别为 p = 0.95 和 p = 0.79）。结论。我们的研究结果表明，近年来 RA 患者的总体心血管死亡率，特别是冠心病死亡率显着改善。需要进一步的研究来检验这种改进的原因。
Objective. To assess trends in cardiovascular (CV) mortality in patients with incident rheumatoid arthritis (RA) in 2000-07 versus the previous decades, compared with non-RA subjects.Methods. The study population consisted of Olmsted County, Minnesota, USA residents with incident RA (age >= 18 yrs, 1987 American College of Rheumatology criteria was met in 1980-2007) and non-RA subjects from the same underlying population with similar age, sex, and calendar year of index. All subjects were followed until death, migration, or December 31, 2014. Followup was truncated for comparability. Aalen-Johansen methods were used to estimate CV mortality rates, adjusting for competing risk of other causes. Cox proportional hazards models were used to compare CV mortality by decade.Results. The study included 813 patients with RA and 813 non-RA subjects (mean age 55.9 yrs; 68% women for both groups). Patients with incident RA in 2000-07 had markedly lower 10-year overall CV mortality (2.7%, 95% CI 0.6-4.9%) and coronary heart disease (CHD) mortality (1.1%, 95% CI 0.0-2.7%) than patients diagnosed in 1990-99 (7.1%, 95% CI 3.9-10.1% and 4.5%, 95% CI 1.9-7.1%, respectively; HR for overall CV death: 0.43, 95% CI 0.19-0.94; CHD death: HR 0.21, 95% CI 0.05-0.95). This improvement in CV mortality persisted after accounting for CV risk factors. Ten-year overall CV mortality and CHD mortality in 2000-07 RA incidence cohort was similar to non-RA subjects (p = 0.95 and p = 0.79, respectively).Conclusion. Our findings suggest significantly improved overall CV mortality, particularly CHD mortality, in patients with RA in recent years. Further studies are needed to examine the reasons for this improvement.