Cardiovascular death in rheumatoid arthritis: A population‐based study

Kremers, Hilal Maradit; Nicola, Paulo; Crowson, Cynthia S.; Ballman, Karla V.; Gabriel, Sherine E.

doi:10.1002/art.20878

Cited by 847 publications

(641 citation statements)

References 65 publications

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“…Both previous studies that examined the association between smoking and CVD mortality failed to find a significant association 25, 26. In the study from the Mayo clinic 26, current smokers had double the risk of cardiovascular death compared to never smokers, although this finding did not reach statistical significance (HR 1.98 [95% CI 0.93, 4.24]), perhaps because the study was underpowered (603 patients).…”

Section: Discussionmentioning

confidence: 84%

“…In the study from the Mayo clinic 26, current smokers had double the risk of cardiovascular death compared to never smokers, although this finding did not reach statistical significance (HR 1.98 [95% CI 0.93, 4.24]), perhaps because the study was underpowered (603 patients). We did not find a significant association between current smoking and deaths due to all‐site cancer but found a strong association between current smoking and deaths due to lung cancer.…”

Section: Discussionmentioning

confidence: 97%

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Smoking‐Related Mortality in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study Using the Clinical Practice Research Datalink

Joseph

Movahedi

Dixon

et al. 2016

Arthritis Care & Research

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ObjectiveTo investigate the association between smoking status and smoking cessation with mortality in patients with rheumatoid arthritis (RA).MethodsAn incident cohort of patients with RA was identified using the Clinical Practice Research Datalink, a database of UK primary care electronic medical records. Time‐varying smoking status, years of cessation, and amount smoked were determined from patients' medical records. The date and underlying cause of death were identified by linkage with Office for National Statistics records. The associations between smoking status and smoking cessation with all‐cause and cause‐specific mortality (circulatory disease, all cancers, lung cancer, respiratory disease, and respiratory infection) were investigated using adjusted Cox (all‐cause mortality) and Fine‐Gray (cause‐specific mortality) regression.ResultsThe cohort comprised 5,677 patients (median age 61.4 years, 68% women), with 40% as never smokers, 34% former smokers, and 26% current smokers at baseline. Compared to never smoking, current smoking was associated with an increased risk of all‐cause mortality (hazard ratio 1.98 [95% confidence interval (95% CI) 1.56, 2.53]), and mortality due to circulatory disease (subdistribution hazard ratio [SHR] 1.96 [95% CI 1.33, 2.90]) and lung cancer (SHR 23.2 [95% CI 5.15, 105]). Each year of smoking cessation was associated with a decreased risk of all‐cause mortality (former heavy smokers SHR 0.85 [95% CI 0.77, 0.94], former light smokers SHR 0.90 [95% CI 0.84, 0.97]).ConclusionCurrent smoking is associated with an increased risk of all‐cause, cardiovascular, and lung cancer mortality in patients with RA. Each year of cessation is associated with a reduced risk of all‐cause mortality. This information may prove helpful in smoking cessation programs for patients with RA.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 97%

Smoking‐Related Mortality in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study Using the Clinical Practice Research Datalink

Joseph

Movahedi

Dixon

et al. 2016

Arthritis Care & Research

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“…Studies have reported that patients with RA exhibit a doubled risk of myocardial infarction and 60% increased risk of cardiovascular mortality compared with the general population 42. An increased prevalence of traditional risk factors, such as diabetes mellitus, hypertension, obesity, smoking, and physical inactivity, may explain, in part, this excess cardiovascular risk in RA 8, 11.…”

Section: Discussionmentioning

confidence: 99%

Incident Heart Failure in Patients With Rheumatoid Arthritis: A Nationwide Cohort Study

Khalid

Egeberg

Ahlehoff

et al. 2018

JAHA

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BackgroundRheumatoid arthritis (RA) is a chronic inflammatory disease associated with a wide range of comorbidities, including cardiovascular disease, but its association with heart failure (HF) is not fully clear. We investigated the risk of incident HF in a nationwide cohort of patients with RA.Methods and ResultsThe study comprised the entire Danish population aged ≥18 years followed from January 1, 2008 until first hospitalization for HF, emigration, December 31, 2012, or death. Information on comorbidity, medication, and socioeconomic status was identified by individual‐level linkage of administrative registers. Patients with a rheumatologist diagnosis of RA between 1978 and 2008 were included. The primary study outcome was incident HF defined as first hospital admission for HF. Incidence rates of HF per 1000 person‐years were calculated and incidence rate ratios adjusted for age, sex, calendar year, comorbidity, medications, socioeconomic status, smoking, and alcohol consumption were estimated. A total of 4 305 225 subjects with no history of HF were eligible for analysis at the study start. Of these subjects, 24 343 developed RA and 50 623 were hospitalized for HF. Overall incidence rates of incident HF were 2.43 and 6.64 for the reference population (n=49 879) and patients with RA (n=744), respectively. Correspondingly, the fully adjusted incidence rate ratio for incident HF was increased in patients with RA with incidence rate ratio 1.30 (95% confidence interval, 1.17–1.45).ConclusionsIn this cohort study, RA was associated with an increased hospitalization for HF. These findings add significantly to the existing evidence of RA as a clinically relevant risk factor for HF.

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“…The study population consisted of a previously described retrospective population-based incidence cohort of adult RA patients ages Ն18 years residing in Rochester, Minnesota, between January 1, 1955 and January 1, 1995 (15)(16)(17). The RA incidence date was defined as the date on which the subject first fulfilled the American College of Rheumatology (ACR; formerly, the American Rheumatism Association) classification criteria (24).…”

Section: Methodsmentioning

confidence: 99%

“…Patients with RA are at increased risk of CVD, including myocardial infarction (MI) and heart failure (HF), as well as CV mortality (15)(16)(17)(18)(19). Chronic inflammation that occurs in this population is believed to contribute to the increased risk (20,21).…”

mentioning

confidence: 99%

Glucocorticoids and cardiovascular events in rheumatoid arthritis: A population‐based cohort study

Davis¹,

Kremers²,

Crowson³

et al. 2007

Arthritis & Rheumatism

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219

122

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Objective. To determine the relationship between glucocorticoid exposure and cardiovascular (CV) events in patients with rheumatoid arthritis (RA).Methods. A total of 603 adult residents of Rochester, Minnesota with incident RA between 1955 and 1995 were followed up through their medical records for a median of 13 years (total of 9,066 person-years). Glucocorticoid exposure was defined 3 ways: tertiles of cumulative exposure; recent use (<3 months) versus past use (>3 months); and average daily dosage (<7.5 mg/day or >7.5 mg/day). CV events, including myocardial infarction, heart failure, and death from CV causes, were defined according to validated criteria. Cox regression models were adjusted for demographic features, CV risk factors, and RA characteristics.Results. Rheumatoid factor (RF)-negative patients with exposure to glucocorticoids were not at increased risk of CV events, irrespective of the glucocorticoid dosage or timing of use, as compared with the reference group of RF-negative patients who had never been exposed to glucocorticoids. In contrast, RFpositive patients were at increased risk of CV events, particularly with higher cumulative exposure, higher average daily dosage, and recent use of glucocorticoids. RF-positive patients with high cumulative exposure to glucocorticoids had a 3-fold increased risk of CV events (hazard ratio 3.06 [95% confidence interval 1.81-5.18]), whereas RF-negative patients with high cumulative exposure were not at increased risk (hazard ratio 0.85 [95% confidence interval 0.39-1.87]).Conclusion. RF-positive but not RF-negative patients were at increased risk of CV events following exposure to glucocorticoids. These findings suggest that glucocorticoids interact with RF status to modulate the occurrence of CV events in patients with RA. The mechanisms underlying this interaction are unknown and should be the subject of further research.

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Cardiovascular death in rheumatoid arthritis: A population‐based study

Cited by 847 publications

References 65 publications

Smoking‐Related Mortality in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study Using the Clinical Practice Research Datalink

Smoking‐Related Mortality in Patients With Early Rheumatoid Arthritis: A Retrospective Cohort Study Using the Clinical Practice Research Datalink

Incident Heart Failure in Patients With Rheumatoid Arthritis: A Nationwide Cohort Study

Glucocorticoids and cardiovascular events in rheumatoid arthritis: A population‐based cohort study

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