类风湿关节炎患者发生充血性心力衰竭的风险：一项为期46年的基于人群的研究。

The risk of congestive heart failure in rheumatoid arthritis: a population-based study over 46 years.

作者信息

Nicola Paulo J, Maradit-Kremers Hilal, Roger Véronique L, Jacobsen Steven J, Crowson Cynthia S, Ballman Karla V, Gabriel Sherine E

机构信息

Mayo Clinic, Rochester, Minnesota 55905, USA.

出版信息

Arthritis Rheum. 2005 Feb;52(2):412-20. doi: 10.1002/art.20855.

DOI:10.1002/art.20855

PMID:15692992

Abstract

OBJECTIVE

It is hypothesized that the systemic inflammation associated with rheumatoid arthritis (RA) promotes an increased risk of cardiovascular (CV) morbidity and mortality. We examined the risk and determinants of congestive heart failure (CHF) in patients with RA.

METHODS

We assembled a population-based, retrospective incidence cohort from among all individuals living in Rochester, Minnesota, in whom RA (defined according to the American College of Rheumatology 1987 criteria) was first diagnosed between 1955 and 1995, and an age- and sex-matched non-RA cohort. After excluding patients in whom CHF occurred before the RA index date, all subjects were followed up until either death, incident CHF (defined according to the Framingham Heart Study criteria), migration from the county, or until January 1, 2001. Detailed information from the complete medical records (including all inpatient and outpatient care provided by all local providers) regarding RA, ischemic heart disease, and traditional CV risk factors was collected. Cox models were used to estimate the effect of RA on the development of CHF, adjusting for CV risk factors and/or ischemic heart disease.

RESULTS

The study population included 575 patients with RA and 583 subjects without RA. The CHF incidence rates were 1.99 and 1.16 cases per 100 person-years in patients with RA and in non-RA subjects, respectively (rate ratio 1.7, 95% confidence interval [95% CI] 1.3-2.1). After 30 years of followup, the cumulative incidence of CHF was 34.0% in patients with RA and 25.2% in non-RA subjects (P< 0.001). RA conferred a significant excess risk of CHF (hazard ratio [HR] 1.87, 95% CI 1.47-2.39) after adjusting for demographics, ischemic heart disease, and CV risk factors. The risk was higher among patients with RA who were rheumatoid factor (RF) positive (HR 2.59, 95% CI 1.95-3.43) than among those who were RF negative (HR 1.28, 95% CI 0.93-1.78).

CONCLUSION

Compared with persons without RA, patients with RA have twice the risk of developing CHF. This excess risk is not explained by traditional CV risk factors and/or clinical ischemic heart disease.

摘要

目的

有假设认为，类风湿关节炎（RA）相关的全身炎症会增加心血管（CV）疾病的发病风险和死亡率。我们研究了RA患者发生充血性心力衰竭（CHF）的风险及决定因素。

方法

我们从明尼苏达州罗切斯特市所有居民中选取了一个基于人群的回顾性发病队列，这些居民在1955年至1995年间首次被诊断为RA（根据美国风湿病学会1987年标准定义），并选取了一个年龄和性别匹配的非RA队列。排除在RA索引日期之前发生CHF的患者后，对所有受试者进行随访，直至死亡、发生CHF（根据弗明汉心脏研究标准定义）、从该县迁出或直至2001年1月1日。收集了完整医疗记录（包括所有当地医疗机构提供的所有住院和门诊护理）中关于RA、缺血性心脏病和传统CV危险因素的详细信息。使用Cox模型评估RA对CHF发生的影响，并对CV危险因素和/或缺血性心脏病进行校正。

结果

研究人群包括575例RA患者和583例非RA受试者。RA患者和非RA受试者的CHF发病率分别为每100人年1.99例和1.16例（发病率比1.7，95%置信区间[95%CI]1.3 - 2.1）。经过30年的随访，RA患者CHF的累积发病率为34.0%，非RA受试者为25.2%（P < 0.001）。在对人口统计学、缺血性心脏病和CV危险因素进行校正后，RA导致CHF的风险显著增加（风险比[HR]1.87，95%CI 1.47 - 2.39）。类风湿因子（RF）阳性的RA患者的风险（HR 2.59，95%CI 1.95 - 3.43）高于RF阴性的患者（HR 1.28，95%CI 0.93 - 1.78）。