Association of cardiovascular disease and traditional cardiovascular risk factors with the incidence of dementia among patients with rheumatoid arthritis.
Association of cardiovascular disease and traditional cardiovascular risk factors with the incidence of dementia among patients with rheumatoid arthritis.
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类风湿关节炎患者中心血管疾病和传统心血管危险因素与痴呆发病率的关系
DOI：
10.1016/j.semarthrit.2020.09.022
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发表时间：
2021-03
影响因子：
5
通讯作者：
Navarro-Millán I
中科院分区：
文献类型：
--
作者：
Sattui SE;Rajan M;Lieber SB;Lui G;Sterling M;Curtis JR;Mandl LA;Navarro-Millán I
[目的]了解65岁及以上类风湿关节炎(RA)患者痴呆的发生率，并比较类风湿性关节炎(RA)患者合并心血管疾病(CVD)、心血管危险因素(CVD)和无心血管疾病(CVD)的痴呆发生率(参照组)。我们分析了2006-2014年间医疗保险和医疗补助服务中心(CMS)的索赔数据。资格标准包括≥12个月(基准期2006年)的持续医疗和药房保险，风湿科医生诊断的2例类风湿性关节炎和至少1种治疗类风湿性关节炎的药物。使用慢性病数据仓库中的代码识别心血管疾病和心血管危险因素。事件痴呆症的定义是1名住院患者或2名门诊患者，或一种针对痴呆症的药物。在每个年龄层内计算年龄调整后的发病率。采用单变量和多变量Cox比例风险模型计算危险比(HR)和95%可信区间。在56,567例类风湿关节炎患者中，11789例(20.1%)的痴呆事件进入主要分析。年龄调整后的发病率在所有人群中都很高，并且随着年龄的增长而增加。在调整了年龄、性别、合并症以及基础的心血管和类风湿关节炎药物治疗后，65-74岁之间有心血管危险因素和心血管危险因素的患者比无心血管危险因素的患者发生痴呆的风险增加(HR分别为1.18(95%CI 1.04-1.33)和HR 1.03(95%CI 1.00-1.11))。我们观察到基线年龄在75岁到84岁之间的心血管疾病患者的风险增加的趋势。与既没有心血管危险因素也没有心血管危险因素的患者相比，仅有心血管和心血管危险因素的类风湿关节炎患者患痴呆症的风险增加；然而，这种风险随着年龄的增长而减弱。RA治疗和CV一级预防策略在预防RA患者痴呆方面的影响值得进一步研究。
To determine the incidence of dementia in patients with rheumatoid arthritis (RA) 65 years and older, and compare the incidence of dementia in patients with RA with prevalent cardiovascular (CV) disease (CVD), CV risk factors but no prevalent CVD and neither (referent group). We analyzed claims data from the Center for Medicare & Medicaid Services (CMS) from 2006-2014. Eligibility criteria included continuous medical and pharmacy coverage for ≥ 12 months (baseline period 2006), > 2 RA diagnoses by a rheumatologist and at least 1 medication for RA. CVD and CV risk factors were identified using codes from the Chronic Condition Data Warehouse. Incident dementia was defined by 1 inpatient or 2 outpatient claims, or one dementia specific medication. Age-adjusted incident rates were calculated within each age strata. Univariate and multivariate Cox proportional hazard models were used to calculate Hazard Ratios (HR) and 95% confidence intervals. Among 56,567 patients with RA, 11,789 (20.1%) incident cases of dementia were included in the main analysis. Age adjusted incident rates were high among all groups and increased with age. After adjustment for age, sex, comorbidities and baseline CV and RA medications, patients with CVD and CV risk factors between 65 and 74 years had an increased risk for incident dementia compared to those without CVD and without CV risk factors (HR 1.18 (95% CI 1.04-1.33) and HR 1.03 (95% CI 1.00-1.11), respectively). We observed a trend towards increased risk in patients between 75 and 84 years with CVD at baseline. Patients with RA with both CVD and CV risk factors alone are at an increased risk for dementia compared to those with neither CVD nor CV risk factors; however, this risk is attenuated with increasing age. The impact of RA treatment and CV primary prevention strategies in the prevention of dementia in patients with RA warrants further studies.
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影响因子：
6.3
作者：
Berry SD;Ngo L;Samelson EJ;Kiel DP
通讯作者：
Kiel DP
影响因子：
3.7
作者：
Lin TM;Chen WS;Sheu JJ;Chen YH;Chen JH;Chang CC
通讯作者：
Chang CC
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
29
作者：
Gottesman, Rebecca F.;Albert, Marilyn S.;Knopman, David S.
通讯作者：
Knopman, David S.
影响因子：
5.4
作者：
Haring B;Leng X;Robinson J;Johnson KC;Jackson RD;Beyth R;Wactawski-Wende J;von Ballmoos MW;Goveas JS;Kuller LH;Wassertheil-Smoller S
通讯作者：
Wassertheil-Smoller S