Cardiovascular, rheumatologic, and pharmacologic predictors of stroke in patients with rheumatoid arthritis: A nested, case-control study
Cardiovascular, rheumatologic, and pharmacologic predictors of stroke in patients with rheumatoid arthritis: A nested, case-control study
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DOI：
10.1002/art.23935
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发表时间：
2008-08-15
期刊：
影响因子：
--
通讯作者：
Wolfe, Frederick
中科院分区：
文献类型：
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作者：
Nadareishvili, Zurab;Michaud, Kaleb;Wolfe, Frederick
Objective.确定类风湿性关节炎（RAJ）患者发生卒中的风险以及与卒中相关的危险因素。我们在纵向数据库中进行了嵌套病例对照分析，将20名年龄、性别和进入队列时间的对照与每位卒中患者进行了匹配。进行条件Logistic回归分析，以评估RA患者与非炎症性风湿性疾病患者相比卒中的相对风险，并检查RA的严重程度和抗肿瘤坏死因子（anti-TNF）治疗效果。我们确定了269例首次所有类别卒中患者和67例缺血性卒中患者，包括41例RA患者。RA中所有类别卒中风险的比值比（OR）为1.64（95%置信区间[95% CI] 1.16-2.30，P = 0.005），缺血性卒中为2.66（95% CI 1.24-5.70，P = 0.012）。高血压、心肌梗死、低剂量阿司匹林、合并症评分、健康评估问卷评分和全关节置换术可预测缺血性卒中，但糖尿病、吸烟、运动或体重指数不能预测缺血性卒中。校正心血管和RA风险因素后，缺血性卒中与罗非昔布相关（P = 0.060，OR 2.27 [95%CI 0.97-5.28]），可能与皮质类固醇使用相关。抗TNF治疗与缺血性卒中无关（P = 0.584，OR 0.80 [95%CI 0.34-1.82]）。RA与卒中风险增加相关，特别是缺血性卒中。中风是由RA严重程度、某些心血管危险因素和合并症预测的。除罗非昔布外，类风湿关节炎治疗似乎与卒中无关，尽管皮质类固醇的作用仍不确定。
Objective. To determine the risk of stroke in patients with rheumatoid arthritis (RAJ and risk factors associated with stroke.Methods. We performed nested case-control analyses within a longitudinal databank, matching up to 20 controls for age, sex, and time of cohort entry to each patient with stroke. Conditional logistic regression was performed as an estimate of the relative risk of stroke in RA patients compared with those with noninflammatory rheumatic disorders, and to examine severity and anti-tumor necrosis factor (anti-TNF) treatment effects in RA.Results. We identified 269 patients with first-ever all-category strokes and 67 with ischemic stroke, including 41 in RA patients. The odds ratio (OR) for the risk of all-category stroke in RA was 1.64 (95% confidence interval [95% CI] 1.16-2.30, P = 0.005), and for ischemic stroke was 2.66 (95% CI 1.24-5.70, P = 0.012). Ischemic stroke was predicted by hypertension, myocardial infarction, low-dose aspirin, comorbidity score, Health Assessment Questionnaire score, and presence of total joint replacement, but not by diabetes, smoking, exercise, or body mass index. Adjusted for cardiovascular and RA risk factors, ischemic stroke was associated with rofecoxib (P = 0.060, OR 2.27 [95% CI 0.97-5.28]), and possibly with corticosteroid use. Anti-TNF therapy was not associated with ischemic stroke (P = 0.584, OR 0.80 [95% CI 0.34-1.82]).Conclusion. RA is associated with increased risk of stroke, particularly ischemic stroke. Stroke is predicted by RA severity, certain cardiovascular risk factors, and comorbidity. Except for rofecoxib, RA treatment does not appear to be associated with stroke, although the effect of corticosteroids remains uncertain.