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Incident myocardial infarction associated with major types of arthritis in the general population: a systematic review and meta-analysis
  1. Orit Schieir1,
  2. Cedomir Tosevski2,
  3. Richard H Glazier3,
  4. Sheilah Hogg-Johnson4,
  5. Elizabeth M Badley1,5
  1. 1 Division of Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
  2. 2 Rouge Valley Health System, Toronto, Ontario, Canada
  3. 3 Department of Family and Community Medicine, Institute for Clinical Evaluative Sciences, Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
  4. 4 Institute for Work and Health, Toronto, Ontario, Canada
  5. 5 Division of Health Care & Outcomes Research, Toronto Western Research Institute, Toronto, Ontario, Canada
  1. Correspondence to Elizabeth M Badley, Toronto Western Research Institute, 399 Bathurst Street, MP-10th Floor, Suite 310, Toronto, Canada M5T 2S8; e.badley{at}


Objective To synthesise, quantify and compare risks for incident myocardial infarction (MI) across five major types of arthritis in population-based studies.

Methods A systematic search was performed in MEDLINE, EMBASE and CINAHL databases with additional manual/hand searches for population-based cohort or case-control studies published in English of French between January 1980 and January 2015 with a measure of effect and variance for associations between incident MI and five major types of arthritis: rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), gout or osteoarthritis (OA), adjusted for at least age and sex. All search screening, data abstraction quality appraisals were performed independently by two reviewers. Where appropriate, random-effects meta-analysis was used to pool results from studies with a minimum of 10 events.

Results We identified a total of 4, 285 articles; 27 met review criteria and 25 criteria for meta-analyses. In studies adjusting for age and sex, MI risk was significantly increased in RA (pooled relative risk (RR): 1.69, 95% CI 1.50 to 1.90), gout (pooled RR: 1.47, 95% CI 1.24 to 1.73), PsA (pooled RR: 1.41, 95% CI 1.17 to 1.69), OA (pooled RR: 1.31, 95% CI 1.01 to 1.71) and tended towards increased risk in AS (pooled RR: 1.24, 95% CI 0.93 to 1.65). Traditional risk factors were more prevalent in all types of arthritis. MI risk was attenuated for each type of arthritis in studies adjusting for traditional risk factors and remained significantly increased in RA, PsA and gout.

Conclusions MI risk was consistently increased in multiple types of arthritis in population-based studies, and was partially explained by a higher prevalence of traditional risk factors in all types of arthritis. Findings support more integrated cardiovascular (CV) prevention strategies for arthritis populations that target both reducing inflammation and enhancing management of traditional CV risk factors.

  • Arthritis
  • Cardiovascular Disease
  • Epidemiology

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  • Handling editor Tore K Kvien

  • Contributors OS designed and prepared the study protocol, developed the search strategy in conjunction with an information specialist, performed search screening, data abstraction, quality appraisal of studies, carried out the analysis and interpretation of results and drafted the manuscript. She is guarantor. CT performed search screening, data abstraction, quality appraisal of studies, revised and approved the manuscript. SH-J, RHG and EMB contributed to the study design, protocol, analysis plan, interpretation of the results and revised and approved the manuscript.

  • Funding OS received a doctoral training award from the Fonds de la Recherche du Québec—Santé. RHG is supported as a Clinician Scientist in the Department of Family and Community Medicine at the University of Toronto and at St. Michael's Hospital.

  • Competing interests None declared.

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

  • Data sharing statement Add data provided within manuscript or as online supplementary material.