Background Patients with rheumatoid arthritis (RA) have a higher mortality risk compared with the general population. This higher mortality risk is mainly attributable to cardiovascular (CV) diseases. The higher CV mortality risk in RA is caused both by traditional CV risk factors and the underlying chronic inflammatory process. Recent years have witnessed the introduction of tight disease control and of more intensive treatment. Moreover, the increased CV risk in patients with RA is nowadays acknowledged and thus the need for CV risk management. These improvements in medical care may have resulted in lower CV mortality. However, there is a lack of recent studies investigating trends in CV mortality over time. Demographic as well as clinical and functional variables predict CV mortality. Until now, the impact of these variables on CV mortality has been studied separately and not in combination. A EULAR task force for CV risk management advocated to study for a broad range of variables the combined contribution (demographic- as well as inflammatory- and traditional risk factors) to CV mortality in patients with RA in large prospective cohort studies .
Objectives To investigate a) the CV mortality in a clinical cohort of patients with established RA in comparison with the general population over 15 years, b) the trend in this CV mortality during the study period, and c) for a broad range of predictors, which baseline variables predict CV mortality.
Methods In 1997, a sample of 1222 patients was randomly selected from the register of a rheumatology outpatient clinic in Amsterdam. Their CV mortality between 1997 and 2012 was obtained from Statistics Netherlands. The Standardized Mortality Ratio (SMR) for CV mortality was calculated. A linear poisson regression analysis was performed to evaluate change in SMR over time. A Cox Regression analysis was performed to determine which baseline variables predicted CV mortality.
Results Mean age of the population at baseline was 60.4 (SD 15.4) years and 72.6% of the patients were women. Estimated SMR (95% Confidence Interval) for CV mortality was 1.23 (1.05, 1.43). The SMR did not decrease statistically significant (3% annually, p=0.16). Higher age, higher Erythrocyte Sedimentation Rate, having CV comorbidity and Diabetes Mellitus (DM) were predictors for CV mortality.
Conclusions The CV mortality among patients with RA in the past 15 years was still higher than in the general population. The CV mortality did not decrease statistically significant. As CV mortality in RA is still higher than in the general population, continued attention for CV diseases in RA is important. Both tight control of disease activity and good care for comorbid conditions (CV diseases and DM) are advocated.
Peters MJ, Symmons DP et al (2010) EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 69(2):325-331
Disclosure of Interest None declared
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