Ann Rheum Dis doi:10.1136/annrheumdis-2011-200726
  • Clinical and epidemiological research
  • Extended report

Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies

  1. Diane Lacaille1,2
  1. 1Arthritis Research Centre of Canada, Vancouver, Canada
  2. 2Division of Rheumatology, University of British Columbia, Vancouver, Canada
  3. 3Centre for Health Evaluation and Outcomes Sciences, Providence Health, University of British Columbia, Vancouver, Canada
  4. 4Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, Canada
  1. Correspondence to Juan Antonio Avina-Zubieta, Arthritis Research Centre of Canada, 895 West 10th Avenue, Vancouver, British Columbia, Canada V5Z 1L7; azubieta{at}
  1. Contributors All authors participated substantially in study design, data analysis and manuscript preparation. In addition, all authors took due care to ensure the integrity of this work. The final manuscript was seen and approved by all of them.

  • Received 10 September 2011
  • Accepted 31 January 2012
  • Published Online First 16 March 2012


Objective To determine the magnitude of the risk of incident cardiovascular disease (CVD; fatal and non-fatal), including acute myocardial infarction (MI), cerebrovascular accidents (CVA) and congestive heart failure (CHF), in patients with rheumatoid arthritis (RA) compared to the general population through a meta-analysis of controlled observational studies.

Methods The authors searched the Medline, Embase, LILACS and Cochrane databases from their inception to June 2011. Observational studies meeting the following criteria were included: (1) prespecified RA criteria; (2) predefined CVD criteria for incident CVD (MI, CVA or CHF); (3) a comparison group; and (4) RR estimates, 95% CI or data for calculating them. The authors calculated the pooled RR using the random-effects model and tested for heterogeneity using the bootstrap version of the Q statistic.

Results Fourteen studies comprising 41 490 patients met the inclusion criteria. Overall, there was a 48% increased risk of incident CVD in patients with RA (pooled RR 1.48 (95% CI 1.36 to 1.62)). The risks of MI and CVA were increased by 68% (pooled RR 1.68 (95% CI 1.40 to 2.03)) and 41% (pooled RR 1.41 (95% CI 1.14 to 1.74)). The risk of CHF was assessed in only one study (RR 1.87 (95% CI 1.47 to 2.39)). Significant heterogeneity existed in all main analyses. Subgroup analyses showed that inception cohort studies were the only group that did not show a significantly increased risk of CVD (pooled RR 1.12 (95% CI 0.97 to 1.65)).

Conclusions Published data indicate that the risk of incident CVD is increased by 48% in patients with RA compared to the general population. Sample and cohort type influenced the estimates of RR.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.