The effect of rheumatoid arthritis on the risk of cerebrovascular disease and coronary artery disease in young adults

Chen, Yih Ru; Hsieh, Fang I.; Chang, Chi Ching; Fang, Nai; Wu, Hsin Chiao; Chiou, Hung Yi

doi:10.1016/j.jcma.2018.03.009

Cited by 14 publications

(9 citation statements)

References 38 publications

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“…The association between these conditions is previously described [52]. The association between stroke and RA in example 2 is also previously described [53, 54]. A disease cluster of cardiovascular diseases, metabolic diseases and mental health problems similar to that used in example 3, has previously been pointed out in a Norwegian population-based study on multimorbidity [18].…”

Section: Discussionmentioning

confidence: 90%

Stroke follow-up in primary care: a Norwegian modelling study on the implications of multimorbidity for guideline adherence

2019

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Background Specialized acute treatment and high-quality follow-up is meant to reduce mortality and disability from stroke. While the acute treatment for stroke takes place in hospitals, the follow-up of stroke survivors largely takes place in general practice. National guidelines give recommendations for the follow-up. However, previous studies suggest that guidelines are not sufficiently adhered to. It has been suggested that this might be due to the complexity of general practice. A part of this complexity is constituted by patients’ multimorbidity; the presence of two or more chronic conditions in the same person. In this study we investigated the extent of multimorbidity among stroke survivors residing in the communities. The aim was to assess the implications of multimorbidity for the follow-up of stroke in general practice. Methods The study was a cross sectional analysis of the prevalence of multimorbidity among stroke survivors in Mid-Norway. We included 51 patients, listed with general practitioners in 18 different clinics. The material consists of the general practitioners’ medical records for these patients. The medical records for each patient were reviewed in a search for diagnoses corresponding to a predefined list of morbidities, resulting in a list of chronic conditions for each participant. These 51 lists were the basis for the subsequent analysis. In this analysis we modelled different hypothetical patients and assessed the implications of adhering to all clinical guidelines affecting their diseases. Result All 51 patients met the criteria for multimorbidity. On average the patients had 4.7 (SD: 1.9) chronic conditions corresponding to the predefined list of morbidities. By modelling implications of guideline adherence for a patient with an average number of co-morbidities, we found that 10–11 annual consultations with the general practitioner were needed for the follow-up of the stable state of the chronic conditions. More consultations were needed for patients with more complex multimorbidity. Conclusions Multimorbidity had a clear impact on the basis for the follow-up of patients with stroke in general practice. Adhering to the guidelines for each condition is challenging, even for patients with few co-morbidities. For patients with complex multimorbidity, adhering to the guidelines is obviously unmanageable.

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Section: Discussionmentioning

confidence: 90%

Stroke follow-up in primary care: a Norwegian modelling study on the implications of multimorbidity for guideline adherence

2019

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“…Indeed, other large studies of cancer overall have also shown no increased (20,43,44) or net decreased risk of cancer (45). Finally, the presence of an association between several comorbidities and RA in this study served as a reassuring positive control given established connections from RA literature including asthma (46), COPD (47), CAD (48), GERD and thyroid disease (20), ILD (49), obesity (18), and neuropathy, including vasculitic neuropathy (50), peripheral neuropathy (51), and carpal tunnel syndrome (52).…”

Section: Discussionmentioning

confidence: 94%

Racial Differences in Multimorbidity and Comorbidities in Rheumatoid Arthritis

Kronzer

Dykhoff

Stevens

et al. 2022

Arthritis Care & Research

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Objective To identify differences in multimorbidity and individual comorbidities among individuals with rheumatoid arthritis (RA), separated by race and ethnicity. Methods This case–control study within OptumLabs Data Warehouse from 2010 to 2019 matched RA cases (defined by 2 codes plus prescription of an RA drug) to non‐RA controls 1:1 on age, sex, race and ethnicity, region, index date of RA, and insurance coverage duration. We defined multimorbidity as the presence of ≥2 or ≥5 validated comorbidities. Logistic regression models calculated adjusted odds of multimorbidity with 95% confidence intervals (95% CIs) within each race and ethnicity. Results We identified 154,391 RA cases and 154,391 controls (mean age 59.6, 76% female). Black enrollees had the most multimorbidity ≥2/≥5 (73.1%, 34.3%); Asian enrollees had the least (52.4%, 17.3%). Adjusted odds of multimorbidity ≥2 and ≥5 in RA cases versus controls was 2.19 (95% CI 2.16–2.23) and 2.06 (95% CI 2.02–2.09), respectively. This increase was similar across race and ethnicity. However, we observed elevated occurrence of certain comorbidities by race and ethnicity versus controls (P < 0.001), including renal disease in White enrollees (4.7% versus 3.2%) and valvular heart disease in Black and White enrollees (3.2% and 2.8% versus 2.6% and 2.2%). Conclusion Multimorbidity is a problem for all RA patients. Targeted identification of certain comorbidities by race and ethnicity may be a helpful approach to mitigate multimorbidity.

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“…RA is an independent risk factor for MI in young adults [21] , [22] . A recent meta-analysis demonstrated that patients with RA had significantly increased risk of CAD (RR = 1.26 [95% CI 1.04–1.52]; p = 0.021) compared to controls [23] .…”

Section: Discussionmentioning

confidence: 97%

Non-traditional risk factors and the risk of myocardial infarction in the young in the US population-based cohort

Krittanawong

Liu

Mahtta

et al. 2020

IJC Heart & Vasculature

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Highlights Young patients with myocardial infarction (MI) have both traditional risk factors and non-traditional risk factors. HTN, smoking, obesity, HLD and a family history of CAD were risks of MI in the young. HIV, SLE, and OSA were all associated with an elevated risk of MI, independent of traditional atherosclerotic risk factors. Close attention should be paid to emerging risk factors such as SLE, HIV and OSA.

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The effect of rheumatoid arthritis on the risk of cerebrovascular disease and coronary artery disease in young adults

Abstract: RA is an independent risk factor for CVD/CAD in young adults. The government should develop policies for preventing early onset hypertension to reduce the incidence of CVD/CAD among young patients with RA.

Cited by 14 publications

References 38 publications

Stroke follow-up in primary care: a Norwegian modelling study on the implications of multimorbidity for guideline adherence

Stroke follow-up in primary care: a Norwegian modelling study on the implications of multimorbidity for guideline adherence

Racial Differences in Multimorbidity and Comorbidities in Rheumatoid Arthritis

Non-traditional risk factors and the risk of myocardial infarction in the young in the US population-based cohort

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