Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Nephrology, Shanghai Tenth People's Hospital, Shanghai, China.
Clin Exp Rheumatol. 2024 Jul;42(7):1459-1466. doi: 10.55563/clinexprheumatol/ppsp71. Epub 2024 Apr 5.
Patients with rheumatoid arthritis (RA) have been found to have a higher cardiovascular disease (CVD) burden. We aimed to examine the associations between Life's Essential 8 (LE8), a metric of cardiovascular health (CVH) recently proposed by the American Heart Association, and all-cause and CVD mortality in RA patients.
This prospective cohort study analysed RA patients from the National Health and Nutrition Examination Survey 2005-2018 with linked mortality data through December 31, 2019. Total LE8 scores were calculated and divided into the high- (LE8 80-100), moderate- (LE8 50-79), and low-CVH (LE8 0-49) groups. Weighted multivariable Cox regression, logistic regression and restricted cubic spline models were applied to explore the association between LE8 and outcomes.
A total of 1424 RA patients were enrolled with a weighted mean age of 57.87 years and female proportion of 58.94%. During a median follow-up of 82 months, 270 all-cause (85 CVD) deaths were recorded. Compared with the high-CVH group, participants in the moderate- and low-CVH groups had an 85.8% and 129.5% increased risk of all-cause mortality, respectively. After adjustment for potential confounders, each 1 point decrease in LE8 score was associated with a 2.6% increased risk of CVD mortality. Subgroup analyses showed significant interactions between LE8 score and non-Hispanic white population with risk of all-cause mortality. The results were robust for all-cause mortality, but not for CVD mortality in the sensitivity analysis.
CVH measured by the LE8 score is a robust and independent predictor of all-cause mortality among U.S. RA patients.
类风湿关节炎（RA）患者的心血管疾病（CVD）负担较高。我们旨在研究最近由美国心脏协会提出的生命的八大要素（LE8）与 RA 患者全因和 CVD 死亡率之间的关系。
本前瞻性队列研究分析了 2005 年至 2018 年国家健康和营养调查（NHANES）中具有 RA 的患者，并通过 2019 年 12 月 31 日的死亡数据进行了关联。计算了总 LE8 评分，并将其分为高（LE8 80-100）、中（LE8 50-79）和低心血管健康（LE8 0-49）组。应用加权多变量 Cox 回归、逻辑回归和限制立方样条模型探讨 LE8 与结局之间的关系。
共纳入 1424 例 RA 患者，加权平均年龄为 57.87 岁，女性比例为 58.94%。中位随访 82 个月期间，记录了 270 例全因（85 例 CVD）死亡。与高 CVH 组相比，中 CVH 和低 CVH 组的全因死亡率分别增加了 85.8%和 129.5%。在调整潜在混杂因素后，LE8 评分每降低 1 分，CVD 死亡率的风险增加 2.6%。亚组分析显示，LE8 评分与非西班牙裔白人人口之间存在全因死亡率的显著交互作用。这些结果在全因死亡率的敏感性分析中是稳健的，但在 CVD 死亡率的分析中不稳健。
由 LE8 评分衡量的心血管健康是美国 RA 患者全因死亡率的一个稳健且独立的预测因子。
