Solomon Daniel H, Karlson Elizabeth W, Rimm Eric B, Cannuscio Carolyn C, Mandl Lisa A, Manson JoAnn E, Stampfer Meir J, Curhan Gary C
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
Circulation. 2003 Mar 11;107(9):1303-7. doi: 10.1161/01.cir.0000054612.26458.b2.
Rheumatoid arthritis may be associated with an increased risk of cardiovascular disease. We compared the incidence rates of myocardial infarction and stroke in subjects with and without rheumatoid arthritis.
A prospective cohort study was conducted among the 114 342 women participating in the Nurses' Health Study who were free of cardiovascular disease and rheumatoid arthritis at baseline in 1976. All self-reported cases of rheumatoid arthritis were confirmed by medical record review. Fatal and nonfatal myocardial infarctions and strokes were similarly confirmed. Multivariate pooled logistic regression was used to adjust for potential cardiovascular risk factors. Five hundred twenty-seven incident cases of rheumatoid arthritis and 3622 myocardial infarctions and strokes were confirmed during 2.4 million person-years of follow-up. The adjusted relative risk of myocardial infarction in women with rheumatoid arthritis compared with those without was 2.0 (95% confidence interval [CI], 1.23 to 3.29). For stroke, the adjusted relative risk was 1.48 (95% CI, 0.70 to 3.12). Women who had rheumatoid arthritis for at least 10 years had a risk for myocardial infarction of 3.10 (95% CI, 1.64 to 5.87).
In this large prospective cohort of women, participants with rheumatoid arthritis had a significantly increased risk of myocardial infarction but not stroke compared with those without rheumatoid arthritis. If these data are confirmed, aggressive coronary heart disease prevention strategies should be tested for persons with rheumatoid arthritis.
类风湿性关节炎可能与心血管疾病风险增加有关。我们比较了患有和未患类风湿性关节炎的受试者中心肌梗死和中风的发病率。
对参加护士健康研究的114342名女性进行了一项前瞻性队列研究，这些女性在1976年基线时无心血管疾病和类风湿性关节炎。所有自我报告的类风湿性关节炎病例均通过病历审查得到证实。致命和非致命性心肌梗死及中风也同样得到证实。采用多变量汇总逻辑回归来调整潜在的心血管危险因素。在240万人年的随访期间，确诊了527例类风湿性关节炎新发病例以及3622例心肌梗死和中风病例。与未患类风湿性关节炎的女性相比，患类风湿性关节炎女性发生心肌梗死的校正相对风险为2.0（95%置信区间[CI]，1.23至3.29）。对于中风，校正相对风险为1.48（95%CI，0.70至3.12）。患类风湿性关节炎至少10年的女性发生心肌梗死的风险为3.10（95%CI，1.64至5.87）。
在这个大型女性前瞻性队列中，与未患类风湿性关节炎的女性相比，患类风湿性关节炎的参与者发生心肌梗死的风险显著增加，但中风风险未增加。如果这些数据得到证实，应针对类风湿性关节炎患者测试积极的冠心病预防策略。
