Hoque Md Rashedul, Aviña-Zubieta J Antonio, Lacaille Diane, De Vera Mary A, Qian Yi, McCandless Lawrence, Esdaile John M, Xie Hui
Arthritis Research Canada, Vancouver, and Simon Fraser University, Burnaby, British Columbia, Canada.
Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada.
Arthritis Care Res (Hoboken). 2024 Mar;76(3):426-436. doi: 10.1002/acr.25233. Epub 2023 Dec 18.
We aimed to assess the association between antimalarial adherence and cardiovascular events between incident rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) population-based cohorts.
All patients with incident RA/SLE and incident antimalarial use in British Columbia, Canada, between January 1997 and March 2015 were identified using provincial administrative databases. The outcomes were incident cardiovascular events, including myocardial infarction (MI), stroke, or venous thromboembolism (VTE). The exposure was antimalarial adherence with levels: discontinuation (proportion of days covered [PDC = 0]), nonadherence (0 < PDC < 0.90), and adherence (PDC ≥ 0.90). We used marginal structural models to estimate the effect of antimalarial adherence on the rate of cardiovascular events, accounting for potential confounders.
We identified 16,538 individuals with incident RA/SLE and incident antimalarial use without any cardiovascular event before the index date. Over nine years mean follow-up, 2,174 incident cardiovascular events (13.2%) were observed. The adjusted hazard ratio (aHR) for incident cardiovascular events for antimalarial adherence relative to discontinuation was 0.72 (95% confidence interval [CI] 0.64-0.81) and 1.01 (95% CI 0.90-1.14) for nonadherence. Additionally, the aHRs for all cardiovascular events, MI, stroke, and VTE for adherence relative to nonadherence was 0.71 (95% CI 0.61-0.82), 0.62 (95% CI 0.51-0.75), 0.45 (95% CI 0.36-0.58), and 0.65 (95% CI 0.46-0.93), respectively. We found older age modified the association between antimalarial adherence and cardiovascular events (P = 0.02).
When people newly diagnosed with RA or SLE take their antimalarial regularly as prescribed (PDC ≥ 0.90), they have a 29% lower risk of sustaining a cardiovascular event than patients with a lower degree of adherence (PDC < 0.90) and a 28% lower risk than if they discontinue antimalarials.
我们旨在评估在基于人群的类风湿性关节炎（RA）和系统性红斑狼疮（SLE）队列中，抗疟药依从性与心血管事件之间的关联。
利用加拿大不列颠哥伦比亚省的省级行政数据库，确定了1997年1月至2015年3月期间所有新发RA/SLE且开始使用抗疟药的患者。结局为新发心血管事件，包括心肌梗死（MI）、中风或静脉血栓栓塞（VTE）。暴露因素为抗疟药依从性水平：停药（覆盖天数比例[PDC = 0]）、不依从（0 < PDC < 0.90）和依从（PDC≥0.90）。我们使用边际结构模型来估计抗疟药依从性对心血管事件发生率的影响，并考虑潜在的混杂因素。
我们确定了16538例新发RA/SLE且开始使用抗疟药且在索引日期前无任何心血管事件的个体。在9年的平均随访中，观察到2174例新发心血管事件（13.2%）。抗疟药依从相对于停药的新发心血管事件的校正风险比（aHR）为0.72（95%置信区间[CI] 0.64 - 0.81），不依从的为1.01（95% CI 0.90 - 1.14）。此外，依从相对于不依从的所有心血管事件、MI、中风和VTE的aHR分别为0.71（95% CI 0.61 - 0.82）、0.62（95% CI 0.51 - 0.75）、0.45（95% CI 0.36 - 0.58）和0.65（95% CI 0.46 - 0.93）。我们发现年龄较大改变了抗疟药依从性与心血管事件之间的关联（P = 0.02）。
新诊断为RA或SLE的患者按规定定期服用抗疟药（PDC≥0.90）时，发生心血管事件的风险比依从性较低（PDC < 0.90）的患者低29%，比停用抗疟药的患者低28%。
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