del Rincón I D, Williams K, Stern M P, Freeman G L, Escalante A
University of Texas Health Science Center at San Antonio, 78229-3900, USA.
Arthritis Rheum. 2001 Dec;44(12):2737-45. doi: 10.1002/1529-0131(200112)44:12<2737::AID-ART460>3.0.CO;2-%23.
To compare the incidence of cardiovascular (CV) events in persons with rheumatoid arthritis (RA) with that in people from the general population, adjusting for traditional CV risk factors.
Two hundred thirty-six consecutive patients with RA were assessed for the 1-year occurrence of 1) CV-related hospitalizations, including myocardial infarction, stroke or other arterial occlusive events, or arterial revascularization procedures, or 2) CV deaths. Both outcomes were ascertained by medical records or death certificates. For comparison, we used CV events that occurred during an 8-year period among participants in an epidemiologic study of atherosclerosis and CV disease who were ages 25-65 years at study entry. We calculated the age- and sex-stratified incidence rate ratio (IRR) of CV events between the 2 cohorts and used Poisson regression to adjust for age, sex, smoking status, diabetes mellitus, hypercholesterolemia, systolic blood pressure, and body mass index.
Of the 236 RA patients, 234 were observed for 252 patient-years, during which 15 CV events occurred. Of these, 7 incident events occurred during the 204 patient-years contributed by patients ages 25-65 years, for an incidence of 3.43 per 100 patient-years. In the comparison cohort, 4,635 community-dwelling persons were followed up for 33,881 person-years, during which 200 new events occurred, for an incidence of 0.59 per 100 person-years. The age- and sex-adjusted IRR of incident CV events associated with RA was 3.96 (95% confidence interval [95% CI] 1.86-8.43). After adjusting for CV risk factors using Poisson regression, the IRR decreased slightly, to 3.17 (95% CI 1.33-6.36).
The increased incidence of CV events in RA patients is independent of traditional CV risk factors. This suggests that additional mechanisms are responsible for CV disease in RA. Physicians who provide care to individuals with RA should be aware of their increased risk of CV events and implement appropriate diagnostic and therapeutic measures.
比较类风湿关节炎（RA）患者与普通人群中心血管（CV）事件的发生率，并对传统CV危险因素进行校正。
对236例连续的RA患者进行为期1年的评估，观察1）与CV相关的住院情况，包括心肌梗死、中风或其他动脉闭塞事件、动脉血运重建手术，或2）CV死亡。这两种结局均通过病历或死亡证明确定。为作比较，我们使用了一项动脉粥样硬化和CV疾病流行病学研究中年龄在25 - 65岁的参与者在8年期间发生的CV事件。我们计算了两个队列之间CV事件的年龄和性别分层发病率比（IRR），并使用泊松回归对年龄、性别、吸烟状况、糖尿病、高胆固醇血症、收缩压和体重指数进行校正。
在236例RA患者中，234例被观察了252患者年，在此期间发生了15例CV事件。其中，25 - 65岁患者贡献的204患者年中发生了7例新发事件，发病率为每100患者年3.43例。在比较队列中，4635名社区居住者随访了33881人年，在此期间发生了200例新事件，发病率为每100人年0.59例。与RA相关的新发CV事件的年龄和性别校正IRR为3.96（95%置信区间[95%CI]1.86 - 8.43）。使用泊松回归校正CV危险因素后，IRR略有下降，降至3.17（95%CI 1.33 - 6.36）。
RA患者中CV事件发生率的增加独立于传统CV危险因素。这表明RA中的CV疾病存在其他致病机制。为RA患者提供治疗的医生应意识到其CV事件风险增加，并采取适当的诊断和治疗措施。
