Département de cardiologie, université Paris-Descartes, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 75014 Paris, France.
Arch Cardiovasc Dis. 2010 Apr;103(4):253-61. doi: 10.1016/j.acvd.2010.03.007. Epub 2010 May 18.
While there are convergent data suggesting that overall cardiovascular mortality is increased in patients with rheumatoid arthritis, the relative contributions of myocardial infarction and stroke remain unclear.
We sought to clarify this issue by conducting a meta-analysis of cohort studies on myocardial infarction and stroke in patients with rheumatoid arthritis.
A MEDLINE search from January 1960 to September 2009 and abstracts from international conferences from 2007 to 2009 were searched for relevant literature. All cohort studies reporting on standardized mortality ratio or incidence rate ratio of myocardial or stroke associated with rheumatoid arthritis, with available crude numbers, were included. STATA meta-analysis software was used to calculate pooled risk estimates.
Seventeen papers fulfilled the inclusion criteria, corresponding to a total of 124,894 patients. Ten studies reported on standardized mortality ratio for fatal myocardial infarction, which ranged from 0.99 to 3.82. The overall pooled estimate was 1.77 (95% confidence interval [CI] 1.65-1.89). Incidence rate ratio for myocardial infarction was reported in five studies; the pooled estimate was 2.10 (95% CI 1.52-2.89). Nine studies reported on fatal stroke, with standardized mortality ratio ranging from 1.08 to 2.00; the pooled estimate was 1.46 (95% CI 1.31-1.63). The pooled incidence rate ratio for stroke (three studies) was 1.91 (95% CI 1.73-2.12).
Our results show that risks of myocardial infarction and stroke are increased in patients with rheumatoid arthritis. In addition, both account for the observed increased mortality in individuals with rheumatoid arthritis.
虽然有数据表明类风湿关节炎患者的总体心血管死亡率增加，但心肌梗死和中风的相对贡献仍不清楚。
我们通过对类风湿关节炎患者心肌梗死和中风的队列研究进行荟萃分析，旨在阐明这一问题。
从 1960 年 1 月至 2009 年 9 月对 MEDLINE 进行了检索，并对 2007 年至 2009 年国际会议的摘要进行了检索，以寻找相关文献。所有报告类风湿关节炎相关心肌或中风标准化死亡率比或发病率比的队列研究，均有可用的原始数据，均被纳入。使用 STATA 荟萃分析软件计算汇总风险估计值。
17 篇论文符合纳入标准，共涉及 124894 例患者。10 项研究报告了致命性心肌梗死的标准化死亡率比，范围为 0.99 至 3.82。总体汇总估计值为 1.77（95%置信区间[CI] 1.65-1.89）。有 5 项研究报告了心肌梗死的发病率比；汇总估计值为 2.10（95%CI 1.52-2.89）。9 项研究报告了致命性中风，标准化死亡率比范围为 1.08 至 2.00；汇总估计值为 1.46（95%CI 1.31-1.63）。中风的汇总发病率比（三项研究）为 1.91（95%CI 1.73-2.12）。
我们的结果表明，类风湿关节炎患者发生心肌梗死和中风的风险增加。此外，这两种疾病都导致了类风湿关节炎患者观察到的死亡率增加。
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