Gamarski Roberto, Castro Fernando Ferreira de, Nascimento Jose Antonio Sena do, Abreu Mirhelen Mendes de
Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil.
Arq Bras Cardiol. 2025 Mar 21;122(2):e20240313. doi: 10.36660/abc.20240313. eCollection 2025.
Cardiovascular outcomes in patients with rheumatoid arthritis (RA) have been extensively explored in the literature concerning biological factors.
This nationwide retrospective cohort study aimed to explore the distribution of cardiovascular events in patients with RA in Brazil, assisted by the Unified Health System (SUS), and to identify factors associated with these outcomes.
Patients aged ≥ 18 years were identified from the Brazilian Unified Health System Database (DATASUS) through RA ICD-10 codes and their therapeutic procedures according to SUS guidelines. RA patients treated with disease-modifying antirheumatic drugs (DMARDs) were categorized as biological users and non-biological (synthetic) users. Cardiovascular outcomes, including acute coronary artery disease (ACAD), heart failure, and cerebrovascular accident (CVA), were analyzed. Patients were also categorized based on treatment patterns (switch or constant users). Socioeconomic status was assessed using the FIRJAN Municipal Development Index (IFDM). Descriptive analyses identified population distribution and cardiovascular outcomes, and multiple logistic regression explored associated factors. The statistical significance adopted was p < 0.05.
Among the 4,321 patients with RA treated with DMARDS, 198 cardiovascular outcomes (4.68%) were identified. The majority were female (3,398 [80.3%]) with a mean age of 54.2 (standard deviation 12.8) years, predominantly from the Southeast Region (2,421 [57.2%]). The predominant overall IFDM was > 0.8 (47.5%). Advanced age, the presence of cardiovascular risk factors, and the use of synthetic DMARDs were associated with cardiovascular outcomes.
Cardiovascular outcomes in patients with RA are common and are associated with age, comorbidities, and the drugs used for treatment.
关于生物因素的文献中已广泛探讨了类风湿关节炎（RA）患者的心血管结局。
这项全国性回顾性队列研究旨在探讨在巴西统一卫生系统（SUS）协助下的RA患者中心血管事件的分布情况，并确定与这些结局相关的因素。
根据SUS指南，通过RA的ICD - 10编码及其治疗程序，从巴西统一卫生系统数据库（DATASUS）中识别出年龄≥18岁的患者。接受改善病情抗风湿药物（DMARDs）治疗的RA患者被分为生物制剂使用者和非生物制剂（合成制剂）使用者。分析心血管结局，包括急性冠状动脉疾病（ACAD）、心力衰竭和脑血管意外（CVA）。患者还根据治疗模式（转换使用者或持续使用者）进行分类。使用FIRJAN城市发展指数（IFDM）评估社会经济地位。描述性分析确定人群分布和心血管结局，多因素逻辑回归探索相关因素。采用的统计学显著性为p < 0.05。
在4321例接受DMARDs治疗的RA患者中，识别出198例心血管结局（4.68%）。大多数为女性（3398例[80.3%]），平均年龄为54.2岁（标准差12.8），主要来自东南部地区（2421例[57.2%]）。总体上IFDM主要> 0.8（47.5%）。高龄、存在心血管危险因素以及使用合成DMARDs与心血管结局相关。
RA患者的心血管结局很常见，且与年龄、合并症及所用治疗药物有关。
