Arthritis Research Centre of Canada, 895 West 10th Avenue, Vancouver, British Columbia, Canada V5Z 1L7.
Ann Rheum Dis. 2012 Sep;71(9):1524-9. doi: 10.1136/annrheumdis-2011-200726. Epub 2012 Mar 16.
To determine the magnitude of the risk of incident cardiovascular disease (CVD; fatal and non-fatal), including acute myocardial infarction (MI), cerebrovascular accidents (CVA) and congestive heart failure (CHF), in patients with rheumatoid arthritis (RA) compared to the general population through a meta-analysis of controlled observational studies.
The authors searched the Medline, Embase, LILACS and Cochrane databases from their inception to June 2011. Observational studies meeting the following criteria were included: (1) prespecified RA criteria; (2) predefined CVD criteria for incident CVD (MI, CVA or CHF); (3) a comparison group; and (4) RR estimates, 95% CI or data for calculating them. The authors calculated the pooled RR using the random-effects model and tested for heterogeneity using the bootstrap version of the Q statistic.
Fourteen studies comprising 41 490 patients met the inclusion criteria. Overall, there was a 48% increased risk of incident CVD in patients with RA (pooled RR 1.48 (95% CI 1.36 to 1.62)). The risks of MI and CVA were increased by 68% (pooled RR 1.68 (95% CI 1.40 to 2.03)) and 41% (pooled RR 1.41 (95% CI 1.14 to 1.74)). The risk of CHF was assessed in only one study (RR 1.87 (95% CI 1.47 to 2.39)). Significant heterogeneity existed in all main analyses. Subgroup analyses showed that inception cohort studies were the only group that did not show a significantly increased risk of CVD (pooled RR 1.12 (95% CI 0.97 to 1.65)).
Published data indicate that the risk of incident CVD is increased by 48% in patients with RA compared to the general population. Sample and cohort type influenced the estimates of RR.
通过对对照观察性研究的荟萃分析，确定类风湿关节炎（RA）患者发生心血管疾病（CVD；致死性和非致死性），包括急性心肌梗死（MI）、脑血管意外（CVA）和充血性心力衰竭（CHF）的风险幅度与普通人群相比。
作者检索了 Medline、Embase、LILACS 和 Cochrane 数据库，时间范围为建库至 2011 年 6 月。符合以下标准的观察性研究被纳入：（1）明确的 RA 标准；（2）为新发 CVD（MI、CVA 或 CHF）而预设的 CVD 标准；（3）有对照组；（4）RR 估计值、95%CI 或计算它们的数据。作者使用随机效应模型计算了合并 RR，并使用 Q 统计量的 bootstrap 版本检验了异质性。
14 项包含 41490 名患者的研究符合纳入标准。总体而言，RA 患者新发 CVD 的风险增加了 48%（合并 RR 1.48（95%CI 1.36 至 1.62））。MI 和 CVA 的风险分别增加了 68%（合并 RR 1.68（95%CI 1.40 至 2.03））和 41%（合并 RR 1.41（95%CI 1.14 至 1.74））。仅有一项研究评估了 CHF 的风险（RR 1.87（95%CI 1.47 至 2.39））。所有主要分析均存在显著的异质性。亚组分析表明，起始队列研究是唯一一组未显示 CVD 风险显著增加的研究（合并 RR 1.12（95%CI 0.97 至 1.65））。
已发表的数据表明，与普通人群相比，RA 患者新发 CVD 的风险增加了 48%。样本和队列类型影响 RR 的估计值。
