Hegazy Hatem, Folke Fredrik, Coronel Ruben, Torp-Pedersen Christian, Gislason Gunnar H, Eroglu Talip E
Department of Cardiology, Copenhagen University Hospital, Kobenhavn, Denmark.
Cardiology, Gentofte Hospital, Hellerup, Denmark.
Open Heart. 2022 Jun;9(1). doi: 10.1136/openhrt-2022-001987.
Inflammatory cytokines in patients with rheumatoid arthritis (RA) directly affect cardiac electrophysiology by inhibiting cardiac potassium currents, leading to delay of cardiac repolarisation and QT-prolongation. This may result in lethal arrhythmias. We studied whether RA increases the rate of out-of-hospital cardiac arrest (OHCA) in the general population.
We conducted a nested case-control in a cohort of individuals between 1 June 2001 and 31 December 2015. Cases were OHCA patients from presumed cardiac causes, and were matched with non-OHCA-controls based on age, sex and OHCA date. Cox-regression with time-dependent covariates was conducted to assess the association between RA and OHCA by calculating the HR and 95% CI. Stratified analyses were performed according to sex and presence of cardiovascular diseases. Also, the association between OHCA and use of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with RA was studied.
We included 35 195 OHCA cases of whom 512 (1.45%) had RA, and 351 950 non-OHCA controls of whom 3867 (1.10%) had RA. We found that RA was associated with increased rate of OHCA after adjustment for cardiovascular comorbidities and use of QT-prolonging drugs (HR: 1.22, 95% CI: 1.11 to 1.34). Stratification by sex revealed that increased OHCA rate occurred in women (HR: 1.32, 95% CI: 1.16 to 1.50) but not in men (HR: 1.12, 95% CI: 0.97 to 1.28; P value interaction=0.046). OHCA rate of RA was not further increased in patients with cardiovascular disease. Finally, in patients with RA, use of NSAIDs was not associated with OHCA.
In the general population, RA is associated with increased rate of OHCA in women but not in men.
类风湿关节炎（RA）患者体内的炎性细胞因子通过抑制心脏钾电流直接影响心脏电生理，导致心脏复极延迟和QT间期延长。这可能会引发致命性心律失常。我们研究了RA是否会增加普通人群院外心脏骤停（OHCA）的发生率。
我们在2001年6月1日至2015年12月31日的队列人群中进行了一项巢式病例对照研究。病例为疑似心脏原因导致的OHCA患者，并根据年龄、性别和OHCA日期与非OHCA对照进行匹配。通过计算风险比（HR）和95%置信区间（CI），采用带有时间依赖性协变量的Cox回归来评估RA与OHCA之间的关联。根据性别和心血管疾病的存在情况进行分层分析。此外，还研究了RA患者中OHCA与使用非甾体抗炎药（NSAIDs）之间的关联。
我们纳入了35195例OHCA病例，其中512例（1.45%）患有RA，以及351950例非OHCA对照，其中3867例（1.10%）患有RA。我们发现，在调整心血管合并症和使用延长QT间期药物后，RA与OHCA发生率增加相关（HR：1.22，95%CI：1.11至1.34）。按性别分层显示，女性的OHCA发生率升高（HR：1.32，95%CI：1.16至1.50），而男性则未升高（HR：1.12，95%CI：0.97至1.28；P值交互作用=0.046）。心血管疾病患者中RA的OHCA发生率没有进一步增加。最后，在RA患者中，使用NSAIDs与OHCA无关。
在普通人群中，RA与女性OHCA发生率增加相关，而与男性无关。
