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Risk of cerebrovascular disease associated with the use of glucocorticoids in patients with incident rheumatoid arthritis: a population-based study
  1. J Antonio Aviña-Zubieta1,2,
  2. Michal Abrahamowicz3,
  3. Hyon K Choi1,2,
  4. M Mushfiqur Rahman1,
  5. Marie-Pierre Sylvestre3,4,
  6. John M Esdaile1,2,
  7. Diane Lacaille1,2
  1. 1Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada
  2. 2Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
  4. 4Centre de recherché du CHUM bureau 301 Montréal, Quebec, Canada
  1. Correspondence to Dr J Antonio Aviña-Zubieta, Arthritis Research Centre of Canada, 895 West 10th Avenue, Vancouver, BC V5Z 1L7, Canada; azubieta{at}


Objectives To determine the effect of glucocorticoids (GC) on the risk of cerebrovascular accidents (CVA) in patients with rheumatoid arthritis (RA).

Methods A population-based cohort study was carried out using administrative health data on 7051 individuals with RA onset between 1997 and 2001 and no exposure to GC before RA onset. Follow-up was until 2006. GC exposure was defined in four ways: current use (yes/no), current dose (mg/day), cumulative dose (grams) and cumulative duration of use (years). All were used as time-dependent variables updated monthly. CVA were ascertained using hospitalisation and vital statistics data. Transient ischaemic attacks were not considered as CVA. Cox regression models adjusting for demographics, cardiovascular drug use, propensity scores and RA characteristics were used.

Results The mean age of the cohort was 56 years and 66% were women. Over 6 years' mean follow-up (43 355 person-years), 178 incident CVA cases were identified. GC current use was not associated with a significant increase in the risk of CVA (HR=1.41, 95% CI 0.84 to 2.37). Similarly, the models that accounted for daily dose (HR=1.07, 95% CI 0.94 to 1.21 for each 5 mg increase in the daily dose), cumulative duration of use (HR=1.1, 95% CI 0.94 to 1.32 for each year accumulated in the past) and total cumulative dose (HR=1.04, 95% CI 0.99 to 1.08 per gram accumulated in the past) were also not significantly associated with CVA.

Conclusions This large population-based study indicates that GC use is not associated with an increased risk of CVA in cases with RA.

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  • Funding This research was funded by operating grants from the Canadian Institutes of Health Research (grant 186011) and the Canadian Arthritis Network (grant 08SRID-IJD-02).

  • Competing interests JAA-Z held doctoral and fellowship awards for this research from the Canadian Arthritis Network/the Arthritis Society of Canada, the Canadian Institutes of Health Research, the Michael Smith Foundation for Health Research and the Mexican Institute for Social Security (IMSS) and CONACyT-Mexico. JAA-Z is currently the British Columbia Lupus Society Scholar and a Canadian Arthritis Network/the Arthritis Society of Canada Scholar. M-PS held a doctoral award from the Canadian Institutes of Health Research, DL is the Nancy and Peter Paul Saunders Scholar and holds an investigator award from the Arthritis Society of Canada.

  • Ethics Ethics approval obtained from the University of British Columbia.

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