Incidence of myocardial infarction in patients with rheumatoid arthritis

Davis, Richard F.; Engleman, Edgar G.

doi:10.1002/art.1780170506

Cited by 42 publications

(13 citation statements)

References 24 publications

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“…The decline in AMI risk in rheumatoid arthritis patients is greater in magnitude compared with the decline in AMI mortality rates in the US general population, suggesting possible gains resulting from improving healthcare of these patients. 7 Although our estimate of elevated risk of AMI is similar to many other reports [17][18][19][20][21][22][23][24][25][26][27][28][29] and fits in with the reports of declining overall mortality from Europe, 6,30 some US-based studies have not recorded improvements in total mortality in rheumatoid arthritis. 31 The role of inflammation in AMI has been well described.…”

Section: Discussionsupporting

confidence: 88%

Declines in Mortality From Acute Myocardial Infarction in Successive Incidence and Birth Cohorts of Patients With Rheumatoid Arthritis

2004

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Background-Patients with rheumatoid arthritis are at high risk for acute myocardial infarction (AMI). The treatment of rheumatoid arthritis has become more intensive over the past 2 decades, resulting in tighter control of inflammation and lower levels of disability. The impact of this on atherosclerotic cardiovascular diseases is not known. Methods and Results-Death rates from AMI in a cohort of 3862 patients with rheumatoid arthritis followed up from 1980 to 1997 were studied. Time trends in AMI mortality among successive incidence and birth cohorts were examined by use of multivariable Poisson regression models and by comparing standardized mortality ratios. The mean age was 56 years in this predominantly female cohort (76%), and median disease duration was 6.5 years. During the period of observation, the use of methotrexate increased substantially, whereas that of prednisone was relatively stable. Over the 22 209 person-years of observation, there were 157 deaths as a result of AMI, with a death rate of 7.06 per 1000 person-years. Mortality rates were higher in older age groups and in men. After adjustment for age, sex, race, and disease duration, the risk of AMI declined in successive incidence years (relative risk, 0.94; 95% CI, 0.92 to 0.96). Patients with rheumatoid arthritis incident after 1990 did not have excess AMI mortality compared with general population. Declines in mortality trends were observed in successive birth cohorts as well. Conclusions-Mortality as a result of AMI among patients with rheumatoid arthritis has declined over time. Key Words: myocardial infarction Ⅲ rheumatoid arthritis Ⅲ mortality Ⅲ risk Ⅲ trend A t one time, rheumatoid arthritis was considered a benign disease, and the mainstays of treatment were nonsteroidal antiinflammatory drugs and corticosteroids. 1 Research in the 1970s and 1980s showed that rheumatoid arthritis is not a benign disease and that morbidity and mortality from this disease were high. 2 Over the past 20 to 25 years, there has been a marked shift in the treatment approach to rheumatoid arthritis toward the widespread adoption of early, complete, and sustained control of inflammation as the therapeutic goal. 3 This intensive strategy, likened to tight control of blood sugar in diabetics, has resulted in increased use of diseasemodifying antirheumatic drugs in this period. 4 Several studies have documented a substantial excess mortality in patients with rheumatoid arthritis from AMI and other cardiovascular diseases. 5 It is possible that systemic inflammation in rheumatoid arthritis may lead to an acceleration of atherogenesis. 5 If this thesis is accurate, the dramatic increases in the use of disease-modifying drugs and declines in functional disability that have been recorded in the past 20 years 3 can be expected to have resulted in lower cumulative inflammatory damage in individual patients with rheumatoid arthritis and consequently a lower incidence of atherosclerosis and lower mortality as a result of AMI.Although some studies have suggested a decline...

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Section: Discussionsupporting

confidence: 88%

Declines in Mortality From Acute Myocardial Infarction in Successive Incidence and Birth Cohorts of Patients With Rheumatoid Arthritis

2004

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“…In patients with RF-seropositive RA, an increased frequency of pericarditis (54)(55)(56), valvular disease (54,55), aortic aneurysms (57), as well as a diastolic cardiac dysfunction due to stiffness of the ventricular wall (58) have been demonstrated. In addition, there are studies suggesting an increase in atherosclerosis in RA (59), although others have failed to detect an increase in the incidence of acute myocardial infarction in patients with RA (60,61). It is unclear to what extent this comorbidity in CVD is seen in RFseropositive individuals in the absence of clinical RA, although population studies have demonstrated an increased overall mortality also in this group (14,15).…”

Section: Discussionmentioning

confidence: 99%

Joint swelling as a predictor of death from cardiovascular disease in a population study of Pima Indians

Jacobsson¹,

Turesson²,

Hanson³

et al. 2001

Arthritis & Rheumatism

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“…It is, of course, possible that local concentrations of PGI2 at sites of endothelial injury may reach higher, physiologically important concentrations. Follow-up of patients with rheumatoid arthritis treated with large doses of aspirin does not uncover an increase in thrombosis or atherosclerosis (24,25). Furthermore, patients with congenital cyclooxygenase deficiency who lack PGI2 do not suffer from thrombotic episodes (26).…”

Section: Role Of Eicosanoids In Platelet Functionmentioning

confidence: 99%