Johnson Tate M, Mahabir Chetaj A, Yang Yangyuna, Roul Punyasha, Goldsweig Andrew M, Binstadt Bryce A, Baker Joshua F, Sauer Brian C, Cannon Grant W, Mikuls Ted R, England Bryant R
Medicine & Research Service, VA Nebraska-Western Iowa Health Care System, Omaha.
Division of Rheumatology & Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha.
JAMA Intern Med. 2023 Jul 31;183(9):973-81. doi: 10.1001/jamainternmed.2023.3087.
Although an increased risk of ischemic cardiovascular disease has been associated with rheumatoid arthritis (RA), the risk of aortic stenosis (AS) is unknown.
To examine the risk of incident AS, aortic valve intervention, AS-related death, and risk factors for AS development in patients with RA.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study linked data from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services from 2000 to 2019. Patients with RA were matched by age, sex, and VHA enrollment year with up to 10 patients without RA. The cohort was followed until incident AS, aortic valve intervention, or death. Data were analyzed from August 23, 2022, to March 3, 2023.
the primary exposure was the presence of RA, defined using validated RA algorithms.
Aortic stenosis was defined as a composite of inpatient or outpatient diagnoses, surgical or transcatheter aortic valve replacement, or AS-related death using diagnostic and procedural codes. Risk of AS development was assessed with multivariable Cox proportional hazards models adjusted for race, ethnicity, smoking status, body mass index, rurality, comorbidities, and health care use.
The cohort included 73 070 patients with RA (64 008 [87.6%] males; mean [SD] age, 63.0 [11.9] years) matched with 639 268 patients without RA (554 182 [86.7%] males; mean [SD] age, 61.9 [11.7] years) and 16 109 composite AS outcomes that occurred over 6 223 150 person-years. The AS incidence rate was 3.97 (95% CI, 3.81-4.13) per 1000 person-years in patients with RA and 2.45 (95% CI, 2.41-2.49) per 1000 person-years in the control patients (absolute difference, 1.52 per 1000 person-years). Rheumatoid arthritis was associated with an increased risk of composite AS (adjusted hazard ratio [AHR], 1.48; 95% CI, 1.41-1.55), aortic valve intervention (AHR, 1.34; 95% CI, 1.22-1.48), and AS-related death (AHR, 1.26; 95% CI, 1.04-1.54).
In this cohort study, RA was associated with a higher risk of developing AS and the subsequent risks of undergoing aortic valve intervention and suffering from AS-related death. Future studies are needed to confirm whether valvular heart disease, specifically AS, may be an overlooked cardiovascular disease complication in RA.
尽管缺血性心血管疾病风险增加与类风湿关节炎（RA）相关，但主动脉瓣狭窄（AS）风险尚不清楚。
研究RA患者发生AS、主动脉瓣干预、AS相关死亡的风险以及AS发生的危险因素。
设计、设置和参与者：这项队列研究将2000年至2019年退伍军人健康管理局（VHA）和医疗保险与医疗补助服务中心的数据相链接。RA患者按年龄、性别和VHA登记年份与多达10名无RA患者进行匹配。对该队列进行随访直至发生AS、主动脉瓣干预或死亡。于2022年8月23日至2023年3月3日对数据进行分析。
主要暴露因素为存在RA，采用经过验证的RA算法进行定义。
主动脉瓣狭窄定义为使用诊断和程序编码的住院或门诊诊断、外科或经导管主动脉瓣置换术或AS相关死亡的综合情况。采用多变量Cox比例风险模型评估AS发生风险，并对种族、民族、吸烟状况、体重指数、农村地区、合并症和医疗保健使用情况进行校正。
该队列包括73070例RA患者（64008例[87.6%]为男性；平均[标准差]年龄为63.0[11.9]岁），与639268例无RA患者（554182例[86.7%]为男性；平均[标准差]年龄为61.9[11.7]岁）匹配，在6223150人年期间发生了16109例综合AS结局。RA患者的AS发病率为每1000人年3.97（95%CI，3.81 - 4.13），对照患者为每1000人年2.45（95%CI，2.41 - 2.49）（绝对差异为每1000人年1.52）。类风湿关节炎与综合AS风险增加（校正风险比[AHR]，1.48；95%CI，1.41 - 1.55）、主动脉瓣干预（AHR，1.34；95%CI，1.22 - 1.48）和AS相关死亡（AHR，1.26；95%CI，1.04 - 1.54）相关。
在这项队列研究中，RA与发生AS以及随后接受主动脉瓣干预和AS相关死亡的较高风险相关。未来需要开展研究以确认瓣膜性心脏病，特别是AS，是否可能是RA中一种被忽视的心血管疾病并发症。
