Is Rheumatoid Arthritis a Cardiovascular Risk-Equivalent to Diabetes Mellitus?
Is Rheumatoid Arthritis a Cardiovascular Risk-Equivalent to Diabetes Mellitus?
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DOI：
10.1002/acr.23535
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发表时间：
2018-11-01
影响因子：
4.7
通讯作者：
Zhang, Jie
中科院分区：
文献类型：
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作者：
Curtis, Jeffrey R.;Yang, Shuo;Zhang, Jie
2013年美国心脏病学会/美国心脏协会胆固醇治疗指南推荐他汀类药物用于40-75岁的糖尿病患者，因为他们的心血管疾病（CVD）风险升高。我们根据患者是否患有糖尿病、类风湿性关节炎（RA）、两者都有或两者都没有，比较了住院急性心肌梗死（MI）、卒中和冠状动脉血运重建的发生率。使用2006-2010年私人和公共健康计划索赔，我们确定了4个年龄>40岁的互斥回顾性队列：患有RA和糖尿病的患者、仅患有RA的患者、仅患有糖尿病的患者或两者都不患有的患者。排除了患有CVD的患者。结局包括急性心肌梗死和卒中（根据出院诊断代码确定）和冠状动脉血运重建（根据手术代码确定）。在4个队列中，我们计算了发病率（IR）的结果，标准化到2010年美国人口普查年龄和性别distribution.ResultsConclusionWe确定了920,772名合格的参与者。年龄和性别标准化IR（每1，000人-年）的MI发生率在RA和糖尿病患者中最高（IR 12.6 [95%置信区间（95% CI）10.7-14.7]），其次为仅糖尿病患者（IR 10.7 [95% CI 10.3-11.0]），仅RA（IR 5.7 [95% CI 5.2-6.3]），且两种条件均不存在（IR 4.2 [95%CI 4.1-4.3]）。本研究的结果表明，虽然RA的CVD风险升高，与糖尿病相关的CVD风险相比，其幅度较低。因此，将RA视为糖尿病风险等同于高脂血症管理可能不合适。
ObjectiveMethodsThe 2013 American College of Cardiology/American Heart Association cholesterol treatment guidelines recommend statins for patients with diabetes mellitus ages 40-75 years due to their elevated cardiovascular disease (CVD) risk. We compared the incidence of hospitalized acute myocardial infarction (MI), stroke, and coronary revascularization according to whether patients had diabetes mellitus, rheumatoid arthritis (RA), both, or neither.Using 2006-2010 private and public health plan claims, we identified 4 mutually exclusive retrospective cohorts ages >40 years: patients with RA and diabetes mellitus, RA only, diabetes mellitus only, or neither condition. Patients with prevalent CVD were excluded. Outcomes included acute MI and stroke, identified from inpatient discharge diagnosis codes, and coronary revascularization from procedure codes. Across the 4 cohorts, we calculated incidence rates (IRs) of the outcomes, standardized to the 2010 US census age and sex distribution.ResultsConclusionWe identified 920,772 eligible participants. The age- and sex-standardized IRs (per 1,000 person-years) for MI were highest among patients with RA and diabetes mellitus (IR 12.6 [95% confidence interval (95% CI) 10.7-14.7]), followed by patients with diabetes mellitus only (IR 10.7 [95% CI 10.3-11.0]), RA only (IR 5.7 [95% CI 5.2-6.3]), and with neither condition (IR 4.2 [95% CI 4.1-4.3]).Findings from the present study suggest that while CVD risk in RA is elevated, it is lower in magnitude compared to the CVD risk associated with diabetes mellitus. Therefore, considering RA a diabetes mellitus risk-equivalent with respect to hyperlipidemia management may not be appropriate.