Mortality among arthritics

doi:10.1016/0021-9681(76)90086-2

Journal of Chronic Diseases

Volume 29, Issue 7, July 1976, Pages 459-467

Journal of Chronic D...

https://doi.org/10.1016/0021-9681(76)90086-2 Get rights and content

Abstract

It has been suggested that the chronic ingestion of aspirin might lower the incidence of arterial thrombosis in general and coronary artery disease in particular. To evaluate the association between long-term aspirin ingestion and arteriosclerotic heart disease, mortality was determined in a group of chronic aspirin users—persons with rheumatoid arthritis or with osteoarthritis—and compared to the general population. Relative to the general populations of Massachusetts and of the United States, death among arthritics from arteriosclerotic heart disease was more common than expected. Among persons with rheumatoid arthritis, deaths from all causes were increased by 86%. Among persons with osteoarthritis, deaths from all causes were increased by only 11%, suggesting a mortality factor related to the underlying disease as strong or stronger than any effect of the medication taken. The largest relative excesses occurred from deaths due to diseases of the bones and joints, of the gastrointestinal system, and of the respiratory system.

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Cited by (178)

Hip and Knee Osteoarthritis, Not Nonsteroidal Anti-Inflammatory Drugs, are Linked to Cardiac Disease
2023, Journal of Arthroplasty
In 2005, the Food and Drug Administration placed a black-box warning (the most stringent warning for drugs) on all nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) stating that these agents may cause heart attacks and/or strokes. No level I evidence demonstrates that nonselective NSAIDs increase cardiovascular risk. An alternative hypothesis is that hip and knee osteoarthritis (OA) indirectly causes cardiovascular disease (CVD) through decreased activity and NSAIDs are correlated with CVD as an arthritis treatment.
Systematic reviews were conducted to find observational studies evaluating the association of hip and/or knee OA, CVD, activity, walking, and step counts. The systematic review found studies correlating hip and/or knee OA and CVD morbidity incidence (n = 2); CVD morbidity prevalence (n = 6); odds ratios, relative risks, or hazard ratios of CVD morbidity (n = 11); relative risk, standardized mortality ratios, or hazard ratios of CVD mortality (n = 14); and all-cause mortality hazard ratios associated with NSAID use (n = 3).
Hip OA (5 studies), knee OA (9 studies), and hip and knee OA (6 studies) are linked to an increased risk of CVD morbidity and mortality. Cardiac risk increases with validated disability scores, use of walking aids, walking difficulties, longer follow-up times, younger ages of OA onset, numbers of joints involved, and OA severities. No study linked NSAID use to cardiac disease.
All studies with more than 10-year follow-up linked cardiac disease with hip and knee OA. No study linked nonselective NSAID use to CVD. The Food and Drug Administration should reconsider the black-box warnings on naproxen, ibuprofen, and celecoxib.
Plasma cholesterol homeostasis, HDL remodeling and function during the acute phase reaction
2017, Journal of Lipid Research
Acute phase reaction (APR) is a systemic inflammation triggered by several conditions associated with lipid profile alterations. We evaluated whether APR also associates with changes in cholesterol synthesis and absorption, HDL structure, composition, and cholesterol efflux capacity (CEC). We analyzed 59 subjects with APR related to infections, oncologic causes, or autoimmune diseases and 39 controls. We detected no difference in markers of cholesterol synthesis and absorption. Conversely, a significant reduction of LpA-I- and LpAI:AII-containing HDL (−28% and −44.8%, respectively) and of medium-sized HDL (−10.5%) occurred in APR. Total HDL CEC was impaired in APR subjects (−18%). Evaluating specific CEC pathways, we found significant reductions in CEC by aqueous diffusion and by the transporters scavenger receptor B-I and ABCG1 (−25.5, −41.1 and −30.4%, respectively). ABCA1-mediated CEC was not affected. Analyses adjusted for age and gender provided similar results. In addition, correcting for HDL-cholesterol (HDL-C) levels, the differences in aqueous diffusion total and ABCG1-CEC remained significant. APR subjects displayed higher levels of HDL serum amyloid A (+20-folds; P = 0.003). In conclusion, APR does not associate with cholesterol synthesis and absorption changes but with alterations of HDL composition and a marked impairment of HDL CEC, partly independent of HDL-C serum level reduction.
Clinical assessment of endothelial function in patients with rheumatoid arthritis: A meta-analysis of literature studies
2015, European Journal of Internal Medicine
Citation Excerpt :
With a prevalence of 0.5–1% in the general population, RA is the most common chronic inflammatory condition [2, 3]. Beyond joint disease, RA is characterized by a high prevalence of comorbidities, such as gastrointestinal [4, 5], respiratory [6, 7], and renal diseases [5, 8]. Moreover, metabolic syndrome (MetS) and its major features (obesity, hypertension, impaired fasting glucose, hyperlipidemia) have been frequently found in RA patients [9].
Several studies reported an increased cardiovascular (CV) morbidity and mortality in patients with rheumatoid arthritis (RA). Flow-mediated (FMD) and nitrate-mediated dilation (NMD) are considered non-invasive methods to assess endothelial function and surrogate markers of subclinical atherosclerosis.
We performed a systematic review with meta-analysis and meta-regression of literature studies evaluating the impact of RA on FMD and NMD. Studies evaluating the relationship between RA and markers of CV risk (FMD and NMD) were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. The random-effect method was used for analyses and results were expressed as mean difference (MD).
A total of 20 studies (852 RA patients, 836 controls) were included in the final analysis. In detail, 20 studies with data on FMD (852 cases, 836 controls) and 5 studies with data on NMD (207 cases, 147 controls) were analyzed. Compared to controls, RA patients showed a significantly lower FMD (MD: − 2.16%; 95% CI: − 3.33, − 0.98; P = 0.0003), with no differences in NMD (MD: − 0.41%; 95% CI: − 2.89, 2.06; P = 0.74). Interestingly, a lower FMD (MD: − 2.00%; 95% CI: − 3.20, − 0.80; P = 0.001) and no differences in NMD (P = 0.49) were confirmed when excluding data on patients with early-RA. Meta-regression models showed that a more severe inflammatory status was associated with a more significant impairment in FMD.
RA patients show impaired FMD, which is currently considered an independent predictor of CV events. The presence of endothelial dysfunction in RA should be taken into account to plan adequate prevention strategies and therapeutic approaches.
Carotid atherosclerosis in patients with rheumatoid arthritis and rheumatoid nodules
2013, Reumatologia Clinica
Citation Excerpt :
The mortality rate in patients with RA increases during the course of the disease with a tendency to accelerate after 15 years.10 The main causes of death are cardiovascular (37.4%), cerebrovascular (9.4%), and pulmonary diseases (10%), neoplasias (10.3%), and infections (15.2%).6,9,11–21 This information is from hospital22–28 and community studies20,21 that confirm that mortality is due mainly to cardiovascular disease.
To determine whether an association exists between the presence of rheumatoid nodules and thickening of the intima-media and plaque of the carotid artery, which is evidence of atherosclerosis.
Observational, cross-sectional study of 124 patients with rheumatoid arthritis from a University Hospital clinic from 2005 to 2006. We divided the patients into 2 groups, 62 with rheumatoid nodules and 62 without rheumatoid nodules, matched for age and sex. Medical history, erythrocyte sedimentation rate, anti-cyclic citrullinated peptide, rheumatoid factor, and a high resolution doppler ultrasound of the carotid arteries were performed.
Women comprised 89.5% of the patients. The prevalence of a carotid plaque was 57% in our population. The presence of a plaque was associated with age, arterial hypertension and abdominal circumference. Average intima-media thickness (IMT) in patients with a plaque was 0.085 cm (±0.02). There was no correlation between laboratory parameters and thickening of the intima-media of the carotid artery. Subcutaneous nodules were present in 33 (47%) of the 70 patients with a carotid plaque and in 29 (54%) of patients without a carotid plaque (p = .471).
We did not find an association between rheumatoid nodules and the presence of a carotid plaque and thickening of the intima-media of the carotid in patients with rheumatoid arthritis.
Determinar si existe una asociación entre la presencia de nódulos reumatoides y el engrosamiento de la íntima-media y de placa de las arterias carótidas.
Estudio observacional, transversal de 124 pacientes con artritis reumatoide del Servicio de Reumatología de un Hospital Universitario desde 2005 a 2006. Se dividieron los pacientes en 2 grupos, 62 con nódulos reumatoide y 62 sin nódulos reumatoides, pareados por edad y sexo. Se realizó una historia clínica completa, velocidad de sedimentación globular, medición de anticuerpos antipéptidos cíclicos citrulinados, factor reumatoide y una ecografía doppler de alta resolución de las arterias carótidas.
Las mujeres comprendieron el 89,5% de los pacientes. La prevalencia de al menos una placa en las carótidas fue del 57% en nuestra población. La presencia de placa carotídea estuvo asociada a la edad, hipertensión arterial y circunferencia abdominal. El grosor promedio de la íntima-media en pacientes con placa carotídea fue 0,085 cm (± 0,02). No hubo ninguna correlación entre los parámetros de laboratorio y el engrosamiento de íntima-media de la arteria carótida. Los nódulos subcutáneos estuvieron presentes en 33 (47%) de los 70 pacientes con placas de carótida y 29 (54%) de los pacientes sin una placa carótida (p = 0,471).
No hemos encontrado una asociación entre nódulos reumatoides y la presencia de placa y/o el engrosamiento de la íntima-media de carótidas en pacientes con artritis reumatoide.
High risk of clinical cardiovascular events in rheumatoid arthritis: Levels of associations of myocardial infarction and stroke through a systematic review and meta-analysis
2010, Archives of Cardiovascular Diseases
While there are convergent data suggesting that overall cardiovascular mortality is increased in patients with rheumatoid arthritis, the relative contributions of myocardial infarction and stroke remain unclear.
We sought to clarify this issue by conducting a meta-analysis of cohort studies on myocardial infarction and stroke in patients with rheumatoid arthritis.
A MEDLINE search from January 1960 to September 2009 and abstracts from international conferences from 2007 to 2009 were searched for relevant literature. All cohort studies reporting on standardized mortality ratio or incidence rate ratio of myocardial or stroke associated with rheumatoid arthritis, with available crude numbers, were included. STATA meta-analysis software was used to calculate pooled risk estimates.
Seventeen papers fulfilled the inclusion criteria, corresponding to a total of 124,894 patients. Ten studies reported on standardized mortality ratio for fatal myocardial infarction, which ranged from 0.99 to 3.82. The overall pooled estimate was 1.77 (95% confidence interval [CI] 1.65–1.89). Incidence rate ratio for myocardial infarction was reported in five studies; the pooled estimate was 2.10 (95% CI 1.52–2.89). Nine studies reported on fatal stroke, with standardized mortality ratio ranging from 1.08 to 2.00; the pooled estimate was 1.46 (95% CI 1.31–1.63). The pooled incidence rate ratio for stroke (three studies) was 1.91 (95% CI 1.73–2.12).
Our results show that risks of myocardial infarction and stroke are increased in patients with rheumatoid arthritis. In addition, both account for the observed increased mortality in individuals with rheumatoid arthritis.
La mortalité cardiaque globale est augmentée au cours de la polyarthrite rhumatoïde, mais le niveau de risque de survenue d’un infarctus du myocarde et d’un accident vasculaire cérébral demeurent incertains.
Préciser ce niveau de risque à l’aide d’une méta-analyse.
La recherche a été effectuée sur Medline, de janvier 1960 à septembre 2009 et à partir des abstracts des conférences internationales de 2007 à 2009. Les études de cohorte rapportant les risques de mortalité (SMR) et les taux d’incidence (IRR) d’infarctus du myocarde ou d’accident vasculaire cérébral au cours de la polyarthrite rhumatoïde ont été inclues.
Dix-sept articles et/ou abstracts ont été retenus, ce qui correspond à une population totale de 124 894 patients. Dix études rapportent le SMR pour l’infarctus du myocarde fatal; il varie entre 0,99 et 3,82 selon les études. Le SMR global calculé est de 1,77 (IC 95 % : 1,65–1,89). Le risque de survenue d’infarctus du myocarde total a été rapporté dans cinq études ; le risque global calculé est de 2,10 (IC 95 % : 1,52–2,89). Neuf études ont rapporté le risque d’accident vasculaire cérébral fatal avec des SMR compris entre 1,08 et 2,00 ; le SMR global est de 1,46 (IC 95 % : 1,31–1,63). Le risque d’accident vasculaire cérébral total est de 1,91 (IC 95 % : 1,73–2,12).
Nos résultats montrent qu’il existe un sur-risque d’infarctus du myocarde et d’accident vasculaire cérébral au cours de la polyarthrite rhumatoïde ; tous deux contribuent à la surmortalité observée au cours de la polyarthrite rhumatoïde.
Mortality in established rheumatoid arthritis
2007, Best Practice and Research: Clinical Rheumatology
Rheumatoid arthritis (RA) is associated with reduced life expectancy. Whether the development of RA initiates this process of premature ageing or is part of it is not clear. The excess mortality is apparent within the first few years of disease and increases with RA disease duration. Most of the excess deaths are attributable to infection, cardiovascular disease (in particular coronary heart disease) and respiratory disease. Deaths due to lung cancer and non-Hodgkin's lymphoma, but not other cancers, are also increased. There is some evidence that effective disease-modifying therapy can improve survival but, overall, survival in RA patients has not improved to the same degree as in the general population over recent decades.

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Mortality among arthritics

Abstract

Lancet

Lancet

Comput Biomed Res

Regular aspirin intake and acute myocardial infarction

Brit Med J

Acetylsalicylic acid and arteriosclerotic thromboemobolic diseases in the aged

J Amr Geriatrics Soc

Aspirin and myocardial infarction in patients with rheumatoid arthritis

Lancet

Length of life and cause of death in rheumatoid arthritis

New Eng J Med