Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Prolonged Hydroxychloroquine Use Is Associated with Decreased Incidence of Cardiovascular Disease in Rheumatoid Arthritis Patients.
Bili1, Androniki, Tang2, Xiaoqin, Kirchner2, H. Lester, Antohe1, Jana L., Morris3, Stephanie J., Wasko4, Mary Chester
Geisinger Medical Center, Danville, PA
Geisinger Center for Health Research, Danville, PA
Rose Tree Medical AssociatesRiddle Memorial Hos, Danville, PA
West Penn Allegheny Health System, Pittsburgh, PA
Hydroxychloroquine (HCQ) use has been associated with decreased incidence of diabetes (DM) and improved lipid profile in rheumatoid arthritis (RA) patients, but no studies have reported on the relationship between HCQ and cardiovascular disease (CVD) in RA. Given the long half-life of HCQ, we looked at the effect of long-term HCQ use (>36 mo.) and risk of incident CVD in RA patients.
1,881 incident adult RA patients (ICD-9 code 714.0 at >= 2 outpatient encounters with a rheumatologist), diagnosed between 1/1/2001 3/31/2008 were identified. Prevalent cases of CVD [coronary artery disease (CAD), cardiac revascularization procedure, abdominal aortic aneurysm, stroke, transient ischemic attack, peripheral artery disease, arterial revascularization procedure] were excluded (n=52). Primary outcome was time to CAD [ICD-9 code 410, 410414.99 or revascularization procedure (CPT codes 33510, 33548, 92982, 92984, G0290, G0291, 92930, 92981)]. Secondary outcome was time to development of CVD. Cox proportional regression models were used to calculate hazard ratios (HR) of exposure after adjustment for age, gender, race, BMI, LDL, BP, HTN, hyperlipidemia, DM, RF, ESR, TNF-a inhibitors, methotrexate, statin and corticosteroid use. Exposure to HCQ and all other variables were treated as time-variant in the models.
Of the 1,829 patients included in the analysis, 684 (37.4%) patient were ever on HCQ, 138 on HCQ >36 mo. and 546 on HCQ <= 36 mo. Of the 166 cases developing CAD during observation, 102 were HCQ nonusers, 6 in the HCQ > 36 mo. and 58 in the HCQ <= 36 mo. user groups, yielding incidence of 25.4, 7.3 and 31.6 events per 1000 person-years (py), respectively, with incidence rate ratio (IRR) 0.29 (0.130.65, p=0.003) in the >36 months users vs. nonusers. HCQ use >36 months was associated with a reduction in the hazard for developing CAD (HR= 0.28, 95% CI:0.120.68, p=0.005) compared to nonusers. Of the 200 cases developing CVD during observation,126 were never on HCQ, 7 in the HCQ > 36 months and 67 in the HCQ <= 36 months users, yielding incidence of 31.7, 8.6 and 36.9 events per 1000 py, respectively, with IRR 0.27 (0.170.58, p=0.001) in the HCQ >36 mo users vs. nonusers. A similar association was found between HCQ use > 36 months, compared to nonusers, and hazard for developing CVD (HR 0.27, 0.120.60, p=0.005).
In patients with RA, HCQ use for >36 months is associated with a 72% and 73% reduction in the risk of incident of CAD and CVD respectively. These findings support the use of HCQ as an adjunct to other first line DMARDs in RA patients at high risk for CVD.
To cite this abstract, please use the following information:
Bili, Androniki, Tang, Xiaoqin, Kirchner, H. Lester, Antohe, Jana L., Morris, Stephanie J., Wasko, Mary Chester; Prolonged Hydroxychloroquine Use Is Associated with Decreased Incidence of Cardiovascular Disease in Rheumatoid Arthritis Patients. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1168