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Increase in Cardiovascular and Cerebrovascular Disease Prevalence in Rheumatoid Arthritis
FREDERICK WOLFE, BRUCE FREUNDLICH, and WALTER L. STRAUS
ABSTRACT.
Methods. In July 1999, a survey was administered to a sample of 11,572 patients (9,093 with RA, 2479 with OA) from the practices of 709 US community-based rheumatologists. Patients reported past and current myocardial infarction (MI), stroke (cerebrovascular accident, CVA), and lifetime congestive heart failure (CHF), and also provided demographic and clinical information. To estimate the impact of recall bias, medical records were obtained and reviewed for a 50% random sample of the patients reporting CCVD events, with 95% of CCVD reported events confirmed by record review. Results. Patients with RA and OA differed across all demographic variables. In addition, each variable was significantly associated with MI, CHF, and CVA outcomes. Logistic regression was performed to measure the associations of these outcomes with RA as compared to OA, adjusting for age, sex, education level, smoking, income, hypertension, and body mass index. Compared with OA, patients with RA had the following increased risks: for current MI [odds ratio (OR), 95% confidence interval (95% CI)] 2.14, (1.48, 3.09), lifetime MI 1.28 (1.24, 1.33), CHF 1.43 (1.28, 1.59), current CVA 1.70 (1.29, 2.24), and lifetime CVA 1.005 (0.931, 1.196). The adjusted current and lifetime prevalences of MI were 0.76 and 4.14% for RA versus 0.35 and 3.23% respectively for OA; 0.86 and 3.02% (RA) versus 0.50 and 3.03% (OA) for CVA; and for lifetime CHF, 2.34% (RA) versus 1.64% (OA), respectively. Conclusions. RA is associated with an increased risk for CCVD morbidity due to MI, CHF, and probably for CVA, and may be an independent risk factor for these events. (J Rheumatol 2003;30:36-40) Key Indexing Terms:
RHEUMATOID ARTHRITIS
From the National Data Bank for Rheumatic Diseases, Arthritis Research Center Foundation and University of Kansas School of Medicine, Wichita, Kansas; Merck & Co., Inc., West Point, Pennsylvania, USA. F. Wolfe, MD, National Data Bank for Rheumatic Diseases, Arthritis Research Center Foundation and University of Kansas School of Medicine; B. Freundlich, MD; W.L. Strauss, MD, MPH, Merck & Co., Inc. Address reprint requests to Dr. F. Wolfe, Arthritis Research Center Foundation, 1035 N. Emporia, Suite 230, Wichita, KS 67214, USA. Email: fwolfe@arthritis-research.org Submitted July 19, 2001; revision accepted July 12, 2002. |