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Aortic Stenosis Risk in Rheumatoid Arthritis.

作者信息

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

机构信息

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.

出版信息

JAMA Intern Med. 2023 Jul 31;183(9):973-81. doi: 10.1001/jamainternmed.2023.3087.


DOI:10.1001/jamainternmed.2023.3087
PMID:37523173
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10391353/
Abstract

IMPORTANCE: Although an increased risk of ischemic cardiovascular disease has been associated with rheumatoid arthritis (RA), the risk of aortic stenosis (AS) is unknown. OBJECTIVE: 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. EXPOSURES: the primary exposure was the presence of RA, defined using validated RA algorithms. MAIN OUTCOMES AND MEASURES: 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. RESULTS: 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). CONCLUSIONS AND RELEVANCE: 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.

摘要

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[3]
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[4]
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[5]
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[6]
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本文引用的文献

[1]
A Narrowing Mortality Gap: Temporal Trends of Cause-Specific Mortality in a National Matched Cohort Study in US Veterans With Rheumatoid Arthritis.

Arthritis Care Res (Hoboken). 2023-8

[2]
Global epidemiology of rheumatoid arthritis.

Nat Rev Rheumatol. 2022-10

[3]
Contemporary Costs Associated With Transcatheter Versus Surgical Aortic Valve Replacement in Medicare Beneficiaries.

Circ Cardiovasc Interv. 2022-3

[4]
Lipoprotein Proteomics and Aortic Valve Transcriptomics Identify Biological Pathways Linking Lipoprotein(a) Levels to Aortic Stenosis.

Metabolites. 2021-7-16

[5]
Long-Term Outcomes of Surgical Aortic Valve Replacement in Patients with Rheumatoid Arthritis.

J Clin Med. 2021-6-4

[6]
Burden and trajectory of multimorbidity in rheumatoid arthritis: a matched cohort study from 2006 to 2015.

Ann Rheum Dis. 2021-3

[7]
Relative Costs of Surgical and Transcatheter Aortic Valve Replacement and Medical Therapy.

Circ Cardiovasc Interv. 2020-5-14

[8]
The Evolving Management of Aortic Valve Disease: 5-Year Trends in SAVR, TAVR, and Medical Therapy.

Am J Cardiol. 2019-6-7

[9]
Validating the use of veterans affairs tobacco health factors for assessing change in smoking status: accuracy, availability, and approach.

BMC Med Res Methodol. 2018-5-11

[10]
Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications.

BMJ. 2018-4-23

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