Myasoedova Elena, Gabriel Sherine E, Matteson Eric L, Davis John M, Therneau Terry M, Crowson Cynthia S
From the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
E. Myasoedova, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science; C.S. Crowson, MS, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; E.L. Matteson, MD MPH, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; J.M. Davis III, MD, MS, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science; T.M. Therneau, PhD, Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science; S.E. Gabriel, MD, MSc, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, and Rutgers Robert Wood Johnson Medical School.
J Rheumatol. 2017 Jun;44(6):732-739. doi: 10.3899/jrheum.161154. Epub 2017 Apr 1.
To assess trends in cardiovascular (CV) mortality in patients with incident rheumatoid arthritis (RA) in 2000-07 versus the previous decades, compared with non-RA subjects.
The study population consisted of Olmsted County, Minnesota, USA residents with incident RA (age ≥ 18 yrs, 1987 American College of Rheumatology criteria was met in 1980-2007) and non-RA subjects from the same underlying population with similar age, sex, and calendar year of index. All subjects were followed until death, migration, or December 31, 2014. Followup was truncated for comparability. Aalen-Johansen methods were used to estimate CV mortality rates, adjusting for competing risk of other causes. Cox proportional hazards models were used to compare CV mortality by decade.
The study included 813 patients with RA and 813 non-RA subjects (mean age 55.9 yrs; 68% women for both groups). Patients with incident RA in 2000-07 had markedly lower 10-year overall CV mortality (2.7%, 95% CI 0.6-4.9%) and coronary heart disease (CHD) mortality (1.1%, 95% CI 0.0-2.7%) than patients diagnosed in 1990-99 (7.1%, 95% CI 3.9-10.1% and 4.5%, 95% CI 1.9-7.1%, respectively; HR for overall CV death: 0.43, 95% CI 0.19-0.94; CHD death: HR 0.21, 95% CI 0.05-0.95). This improvement in CV mortality persisted after accounting for CV risk factors. Ten-year overall CV mortality and CHD mortality in 2000-07 RA incidence cohort was similar to non-RA subjects (p = 0.95 and p = 0.79, respectively).
Our findings suggest significantly improved overall CV mortality, particularly CHD mortality, in patients with RA in recent years. Further studies are needed to examine the reasons for this improvement.
评估2000 - 2007年新发类风湿关节炎（RA）患者与前几十年相比心血管（CV）死亡率的趋势，并与非RA受试者进行比较。
研究人群包括美国明尼苏达州奥尔姆斯特德县的新发RA患者（年龄≥18岁，1980 - 2007年符合1987年美国风湿病学会标准）以及来自相同基础人群、年龄、性别和索引日历年相似的非RA受试者。所有受试者随访至死亡、迁移或2014年12月31日。为了可比性，随访进行了截断。采用Aalen-Johansen方法估计CV死亡率，并对其他原因的竞争风险进行调整。使用Cox比例风险模型比较不同十年的CV死亡率。
该研究纳入了813例RA患者和813例非RA受试者（平均年龄55.9岁；两组女性均占68%）。2000 - 2007年新发RA患者的10年总体CV死亡率（2.7%，95%置信区间0.6 - 4.9%）和冠心病（CHD）死亡率（1.1%，95%置信区间0.0 - 2.7%）明显低于1990 - 1999年诊断的患者（分别为7.1%，95%置信区间3.9 - 10.1%和4.5%，95%置信区间1.9 - 7.1%；总体CV死亡的风险比：0.43，95%置信区间0.19 - 0.94；CHD死亡：风险比0.21，95%置信区间0.05 - 0.95）。在考虑CV危险因素后，CV死亡率的这种改善仍然存在。2000 - 2007年RA发病队列的10年总体CV死亡率和CHD死亡率与非RA受试者相似（p分别为0.95和0.79）。
我们的研究结果表明，近年来RA患者的总体CV死亡率，尤其是CHD死亡率有显著改善。需要进一步研究以探讨这种改善的原因。
