Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Are Rheumatoid Arthritis Patients Experiencing Less Coronary Heart Disease in Recent Years?
Crowson, Cynthia S., Myasoedova, Elena, Roger, Veronique, Matteson, Eric L., Kremers, Hilal Maradit, Therneau, Terry M., Gabriel, Sherine E.
Patients with rheumatoid arthritis (RA) suffer from an excess burden of coronary heart disease (CHD) and heart failure (HF). The purpose of our study was to examine whether the risk of CHD and HF in RA patients has changed in recent years.
A population-based inception cohort of RA subjects who fulfilled 1987 ACR criteria for RA between 1-1-1980 and 1-1-2008 was assembled and followed until death, migration, or 7-1-2008. The presence of CHD (physician diagnosis of coronary artery disease, hospitalized or silent myocardial infarction [MI], revascularization, angina) and HF (Framingham diagnostic criteria) was ascertained by review of the medical record. Cox proportional hazards models with age as the time scale and adjusted for sex were used to assess the risk of CHD and HF according to calendar year of RA incidence (198084 vs. 19952007). Patients with CHD or HF prior to RA incidence were excluded from the analyses.
The study included 741 RA patients (mean age [SD] 56 [15.8] years, 69% women). The patients were followed up for a mean of 9.6 years during which 89 patients developed CHD (excluding 83 patients with CHD prior to RA incidence] and 82 patients developed HF (excluding 20 patients with HF prior to RA incidence). The 5 year risk of CHD was 7.0% and 4.9% for patients with incident RA in 198094 and 19952007, respectively. The age and sex adjusted risk of CHD was significantly lower in 19952007 compared to 198094 (hazard ratio [HR]: 0.58; 95% confidence interval [CI]: 0.35, 0.95; p=0.03). The 5 year risk of HF was 6.0% and 5.5% for patients with incident RA in 198094 and 19952007, respectively). The age and sex adjusted risk of HF was similar in 199507 compared to 198094 (HR: 0.87; 95% CI: 0.54, 1.40; p=0.57).
The risk of CHD for patients with incident RA declined over time, but the risk of HF was unchanged. This suggests that efforts to reduce CHD risk in RA patients may have been effective in reducing the excess burden. However, the mechanism underlying HF in RA patients may differ from that of CHD. More research is needed to understand the reasons for these trends in the risk of CHD and HF in RA along with intensification of the efforts to prevent HF.
To cite this abstract, please use the following information:
Crowson, Cynthia S., Myasoedova, Elena, Roger, Veronique, Matteson, Eric L., Kremers, Hilal Maradit, Therneau, Terry M., et al; Are Rheumatoid Arthritis Patients Experiencing Less Coronary Heart Disease in Recent Years? [abstract]. Arthritis Rheum 2009;60 Suppl 10 :57