University of Alabama at Birmingham.
Arthritis Care Res (Hoboken). 2018 Nov;70(11):1694-1699. doi: 10.1002/acr.23535.
The 2013 American College of Cardiology/American Heart Association cholesterol treatment guidelines recommend statins for patients with diabetes mellitus ages 40-75 years due to their elevated cardiovascular disease (CVD) risk. We compared the incidence of hospitalized acute myocardial infarction (MI), stroke, and coronary revascularization according to whether patients had diabetes mellitus, rheumatoid arthritis (RA), both, or neither.
Using 2006-2010 private and public health plan claims, we identified 4 mutually exclusive retrospective cohorts ages >40 years: patients with RA and diabetes mellitus, RA only, diabetes mellitus only, or neither condition. Patients with prevalent CVD were excluded. Outcomes included acute MI and stroke, identified from inpatient discharge diagnosis codes, and coronary revascularization from procedure codes. Across the 4 cohorts, we calculated incidence rates (IRs) of the outcomes, standardized to the 2010 US census age and sex distribution.
We identified 920,772 eligible participants. The age- and sex-standardized IRs (per 1,000 person-years) for MI were highest among patients with RA and diabetes mellitus (IR 12.6 [95% confidence interval (95% CI) 10.7-14.7]), followed by patients with diabetes mellitus only (IR 10.7 [95% CI 10.3-11.0]), RA only (IR 5.7 [95% CI 5.2-6.3]), and with neither condition (IR 4.2 [95% CI 4.1-4.3]).
Findings from the present study suggest that while CVD risk in RA is elevated, it is lower in magnitude compared to the CVD risk associated with diabetes mellitus. Therefore, considering RA a diabetes mellitus risk-equivalent with respect to hyperlipidemia management may not be appropriate.
2013 年美国心脏病学会/美国心脏协会胆固醇治疗指南建议，对于年龄在 40-75 岁的糖尿病患者，由于其心血管疾病（CVD）风险升高，使用他汀类药物。我们比较了患有糖尿病、类风湿关节炎（RA）、两者都有或都没有的患者住院急性心肌梗死（MI）、中风和冠状动脉血运重建的发生率。
使用 2006-2010 年私人和公共医疗保健计划的索赔数据，我们确定了 4 个相互排斥的回顾性队列，年龄大于 40 岁：患有 RA 和糖尿病的患者、仅患有 RA 的患者、仅患有糖尿病的患者或两种疾病都没有的患者。排除有既往 CVD 的患者。结果包括急性 MI 和中风，根据住院患者诊断代码识别，以及冠状动脉血运重建，根据程序代码识别。在 4 个队列中，我们计算了结局的发生率（IR），根据 2010 年美国人口普查的年龄和性别分布进行了标准化。
我们确定了 920772 名符合条件的参与者。MI 的年龄和性别标准化发病率（每 1000 人年）在患有 RA 和糖尿病的患者中最高（IR 12.6[95%置信区间（95%CI）10.7-14.7]），其次是仅患有糖尿病的患者（IR 10.7[95%CI 10.3-11.0]）、仅患有 RA 的患者（IR 5.7[95%CI 5.2-6.3]）和两种疾病都没有的患者（IR 4.2[95%CI 4.1-4.3]）。
本研究的结果表明，虽然 RA 中的 CVD 风险升高，但与糖尿病相关的 CVD 风险相比，其幅度较低。因此，将 RA 视为与糖尿病等效的血脂异常管理风险可能并不合适。
