类风湿关节炎患者的心血管风险模式。
Patterns of cardiovascular risk in rheumatoid arthritis.
作者信息
Solomon D H, Goodson N J, Katz J N, Weinblatt M E, Avorn J, Setoguchi S, Canning C, Schneeweiss S
机构信息
Division of Pharmacoepidemiology, Brigham and Women's Hospital, 1620 Tremont Street, Suite 3030, Boston, MA 02120, USA.
出版信息
Ann Rheum Dis. 2006 Dec;65(12):1608-12. doi: 10.1136/ard.2005.050377. Epub 2006 Jun 22.
BACKGROUND
Although it is known that rheumatoid arthritis is associated with an increased risk of cardiovascular disease (CVD), the pattern of this risk is not clear. This study investigated the relative risk of myocardial infarction, stroke and CVD mortality in adults with rheumatoid arthritis compared with adults without rheumatoid arthritis across age groups, sex and prior CVD event status.
METHODS
We conducted a cohort study among all residents aged >or=18 years residing in British Columbia between 1999 and 2003. Residents who had visited the doctor at least thrice for rheumatoid arthritis (International Classification of Disease = 714) were considered to have rheumatoid arthritis. A non-rheumatoid arthritis cohort was matched to the rheumatoid arthritis cohort by age, sex and start of follow-up. The primary composite end point was a hospital admission for myocardial infarction, stroke or CVD mortality.
RESULTS
25 385 adults who had at least three diagnoses for rheumatoid arthritis during the study period were identified. During the 5-year study period, 375 patients with rheumatoid arthritis had a hospital admission for myocardial infarction, 363 had a hospitalisation for stroke, 437 died from cardiovascular causes and 1042 had one of these outcomes. The rate ratio for a CVD event in patients with rheumatoid arthritis was 1.6 (95% confidence interval (CI) 1.5 to 1.7), and the rate difference was 5.7 (95% CI 4.9 to 6.4) per 1000 person-years. The rate ratio decreased with age, from 3.3 in patients aged 18-39 years to 1.6 in those aged >or=75 years. However, the rate difference was 1.2 per 1000 person-years in the youngest age group and increased to 19.7 per 1000 person-years in those aged >or=75 years. Among patients with a prior CVD event, the rate ratios and rate differences were not increased in rheumatoid arthritis.
CONCLUSIONS
This study confirms that rheumatoid arthritis is a risk factor for CVD events and shows that the rate ratio for CVD events among subjects with rheumatoid arthritis is highest in young adults and those without known prior CVD events. However, in absolute terms, the difference in event rates is highest in older adults.
背景
尽管已知类风湿关节炎与心血管疾病（CVD）风险增加相关，但这种风险模式尚不清楚。本研究调查了成年类风湿关节炎患者与无类风湿关节炎的成年人相比，在不同年龄组、性别和既往CVD事件状态下发生心肌梗死、中风和CVD死亡的相对风险。
方法
我们对1999年至2003年间居住在不列颠哥伦比亚省的所有年龄≥18岁的居民进行了一项队列研究。因类风湿关节炎（国际疾病分类=714）至少看三次医生的居民被视为患有类风湿关节炎。一个非类风湿关节炎队列按年龄、性别和随访开始时间与类风湿关节炎队列进行匹配。主要复合终点是因心肌梗死、中风或CVD死亡而住院。
结果
在研究期间确定了25385名至少有三次类风湿关节炎诊断的成年人。在5年的研究期间，375名类风湿关节炎患者因心肌梗死住院，363名因中风住院，437名死于心血管原因，1042名出现上述其中一种情况。类风湿关节炎患者发生CVD事件的率比为1.6（95%置信区间（CI）1.5至1.7），每1000人年的率差为5.7（95%CI 4.9至6.4）。率比随年龄下降，从18 - 39岁患者的3.3降至≥75岁患者的1.6。然而，最年轻年龄组每1000人年的率差为1.2，在≥75岁的患者中增加到每1000人年19.7。在既往有CVD事件的患者中，类风湿关节炎患者的率比和率差并未增加。
结论
本研究证实类风湿关节炎是CVD事件的一个危险因素，并表明类风湿关节炎患者中CVD事件的率比在年轻人和既往无已知CVD事件的人群中最高。然而，从绝对值来看，事件发生率的差异在老年人中最高。
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