Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis - A population-based cohort study
Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis - A population-based cohort study
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DOI：
10.1002/art.20853
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发表时间：
2005-02-01
影响因子：
--
通讯作者：
Gabriel, SE
中科院分区：
文献类型：
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作者：
Maradit-Kremers, H;Crowson, CS;Gabriel, SE
客观的。旨在检查类风湿性关节炎 (RA) 患者与年龄和性别匹配的非 RA 受试者相比的临床冠心病 (CHD) 风险，并在考虑传统 CHD 危险因素后确定 RA 是否是 CHD 的危险因素。方法。我们收集了一个基于人群的发病队列，其中包括 603 名年龄大于或等于 18 岁的明尼苏达州罗彻斯特居民，他们在 1955 年 1 月 1 日至 1995 年 1 月 1 日期间首次满足美国风湿病学会 (ACR) 1987 年的 RA 标准，以及 603 名年龄和性别匹配的非 RA 受试者。所有受试者均从 18 岁开始，直至死亡、移居或 2001 年 1 月 1 日为止，通过其完整的住院和门诊病历进行随访。使用既定的诊断标准收集有关 CHD 事件和传统 CHD 危险因素（糖尿病、高血压、血脂异常、体重指数、吸烟）的数据。 CHD 事件包括住院心肌梗塞 (MI)、未识别的 MI、冠状动脉血运重建手术、心绞痛。胸肌和冠心病猝死。在调整 CHD 风险因素后，使用条件逻辑回归和 Cox 回归模型来估计 RA 诊断之前和之后与 RA 相关的 CHD 风险。结果。在满足 ACR 标准之前的 2 年期间，RA 患者更有可能因急性 MI 住院（比值比 [OR] 3.17，95% 置信区间 [95% CI] 1.16-8.68）或经历未识别的 MI（OR 5.86，95% CI 1.29-26.64），并且不太可能有急性 MI 病史。与非 RA 受试者相比，心绞痛（OR 0.58，95% CI 0.34-0.99）。与 RA 发病日期相比，RA 患者出现未识别 MLS（风险比 [HR] 2.13，95% CI 1.13-4.03）和猝死（FIR 1.94，95% CI 1.06-3.55）的可能性是 RA 患者的两倍，并且接受冠状动脉旁路移植术（HR 0.36，95% CI 0.16-0.80）的可能性较低非 RA 受试者。对 CHD 风险因素的调整并未显着改变风险估计。结论。与非 RA 受试者相比，RA 患者患 CHD 的风险显着更高。 RA 患者报告心绞痛症状的可能性较小，并且更有可能经历未被识别的心肌梗死和心源性猝死。 RA 患者发生 CHD 的风险先于基于 ACR 标准的 RA 诊断，并且该风险不能用 RA 患者中传统 CHD 危险因素发生率的增加来解释。
Objective. To examine the risk of clinical coronary heart disease (CHD) in patients with rheumatoid arthritis (RA) compared with age- and sex-matched non-RA subjects, and to determine whether RA is a risk factor for CHD after accounting for traditional CHD risk factors.Methods. We assembled a population-based incidence cohort of 603 Rochester, Minnesota residents ages greater than or equal to18 years who first fulfilled the American College of Rheumatology (ACR) 1987 criteria for RA between January 1, 1955 and January 1, 1995, and 603 age- and sex -matched non-RA subjects. All subjects were followed up through their complete inpatient and outpatient medical records, beginning at age 18 years until death, migration, or January 1, 2001. Data were collected on CHD events and traditional CHD risk factors (diabetes mellitus, hypertension, dyslipidemia, body mass index, smoking) using established diagnostic criteria. CHD events included hospitalized myocardial infarction (MI), unrecognized MI, coronary revascularization procedures, angina. pectoris, and sudden CHD deaths. Conditional logistic regression and Cox regression models were used to estimate the risk of CHD associated with RA, both prior to and following RA diagnosis, after adjusting for CHD risk factors.Results. During the 2-year period immediately prior to fulfillment of the ACR criteria, RA patients were significantly more likely to have been hospitalized for acute MI (odds ratio [OR] 3.17, 95% confidence interval [95% CI] 1.16-8.68) or to have experienced unrecognized MIs (OR 5.86, 95% CI 1.29-26.64), and less likely to have a history of angina pectoris (OR 0.58, 95% CI 0.34-0.99) compared with non-RA subjects. After the RA incidence date, RA patients were twice as likely to experience unrecognized Mls (hazard ratio [HR] 2.13, 95% CI 1.13-4.03) and sudden deaths (FIR 1.94, 95% CI 1.06-3.55) and less likely to undergo coronary artery bypass grafting (HR 0.36, 95% CI 0.16-0.80) compared with non-RA subjects. Adjustment for the CHD risk factors did not substantially change the risk estimates.Conclusion. Patients with RA have a significantly higher risk of CHD when compared with non-RA subjects. RA patients are less likely to report symptoms of angina and more likely to experience unrecognized MI and sudden cardiac death. The risk of CHD in RA patients precedes the ACR criteria-based diagnosis of RA, and the risk cannot be explained by an increased incidence of traditional CHD risk factors in RA patients.