Nadkarni Anagha, You Min, Resuehr Holly, Curtis Jeffrey R
Bristol-Myers Squibb, Princeton, NJ, USA.
University of Alabama at Birmingham, AL, USA.
J Arthritis. 2015 Dec;4(4). doi: 10.4172/2167-7921.1000178. Epub 2015 Dec 5.
To determine, using data from a real-world setting, the overall and sex-specific risk of cardiovascular (CV) events in patients with rheumatoid arthritis (RA), with or without comorbid hyperlipidemia, relative to those in a non-RA cohort.
This retrospective cohort study using claims data from a US commercial health plan (2005-2011) included patients with RA and a matched non-RA cohort. Cox proportional hazards regression model determined the hazard ratio (HR) for CV events (myocardial infarction, stroke, revascularization procedures), using the presence of RA and hyperlipidemia as the independent variables, controlling for other covariates (age, sex, diabetes, and hypertension).
The incidence of CV events per 1000 person-years was 10.19 for the RA cohort and 6.41 for the non-RA cohort (crude rate ratio [RR] =1.59). Within the RA cohort, incidence was 15.54 for patients with hyperlipidemia and 7.05 for patients without hyperlipidemia (crude RR=2.21); in the non-RA cohort, incidence was 10.55 and 3.82 for those with and without hyperlipidemia, respectively (crude RR=2.76). After controlling for covariates, the HR of CV events among RA patients was 1.68 (95% CI: 1.50, 1.87) relative to non-RA patients. After multivariable adjustment, hyperlipidemia conferred a significant risk of CV events in both RA and non-RA patients; the interaction between RA and hyperlipidemia was not significant (=0.13).
This real-world analysis demonstrates that patients with RA have an increased risk of CV events. Similar to a non-RA cohort, CV event rates were incrementally higher for those patients with hyperlipidemia.
Cardiovascular disease is an increasingly visible topic of concern in the rheumatoid arthritis community. However, there are only limited data that informs both the absolute and relative rates of CVD events, and the contribution of various risk factors such as hyperlipidemia, compared to non-RA populationsThe 'lipid paradox' hypothesis in RA suggests that elevated LDL cholesterol has a negligible effect on CVD risk in RA, unlikely in the general population where it is a well-accepted CVD risk factorThe incidence of CVD events in RA patients was 10/1000 patient years, a 1.6 fold greater risk compared to non-RA patientsThe contribution of hyperlipidemia to CVD risk was associated with comparable or greater absolute increases in the rate of CV events compared to non RA patients, a finding that does not support the lipid paradox.
利用真实世界的数据，确定患有或未患有合并高脂血症的类风湿关节炎（RA）患者相对于非RA队列人群发生心血管（CV）事件的总体风险及性别特异性风险。
这项回顾性队列研究使用了美国商业健康保险计划（2005 - 2011年）的理赔数据，纳入了RA患者及匹配的非RA队列。Cox比例风险回归模型以是否存在RA和高脂血症作为自变量，同时控制其他协变量（年龄、性别、糖尿病和高血压），确定CV事件（心肌梗死、中风、血运重建手术）的风险比（HR）。
RA队列每1000人年的CV事件发生率为10.19，非RA队列则为6.41（粗率比[RR]=1.59）。在RA队列中，高脂血症患者的发生率为15.54，无高脂血症患者为7.05（粗RR = 2.21）；在非RA队列中，有高脂血症者发生率为10.55，无高脂血症者为3.82（粗RR = 2.76）。在控制协变量后，RA患者发生CV事件的HR相对于非RA患者为1.68（95%CI：1.50，1.87）。经过多变量调整后，高脂血症在RA和非RA患者中均赋予了显著的CV事件风险；RA与高脂血症之间的相互作用不显著（P = 0.13）。
这项真实世界分析表明，RA患者发生CV事件的风险增加。与非RA队列相似，高脂血症患者的CV事件发生率更高。
心血管疾病在类风湿关节炎群体中日益成为备受关注的话题。然而，仅有有限的数据可说明CVD事件的绝对和相对发生率，以及与非RA人群相比高脂血症等各种风险因素的作用。RA中的“脂质悖论”假说表明，升高的低密度脂蛋白胆固醇对RA患者的CVD风险影响可忽略不计，这在一般人群中不太可能，因为在一般人群中它是公认的CVD风险因素。RA患者的CVD事件发生率为每1000患者年10次，比非RA患者的风险高1.6倍。与非RA患者相比，高脂血症对CVD风险的作用与CV事件发生率的绝对增加相当或更大,这一发现不支持脂质悖论。
