Wallberg-Jonsson S, Ohman M L, Dahlqvist S R
Department of Rheumatology, University Hospital, Umea, Sweden.
J Rheumatol. 1997 Mar;24(3):445-51.
To investigate the overall and the cardiovascular mortality in rheumatoid arthritis (RA) in Northern Sweden. To analyze the effect of traditional risk factors and factors associated with rheumatoid disease and its treatment on the progression of cardiovascular disease (CVD) and on mortality by all causes.
A cohort of 606 patients with seropositive RA were followed from 1979 to the end of 1994 or to the death of the patient. Standardized mortality ratio and survival curves were estimated with the population of Vasterbotten as reference. Sex, age at disease onset, treatment with corticosteroids, use of disease modifying antirheumatic drugs (DMARD) and hormone replacement therapy (HRT), hypertension, diabetes mellitus, HLA types, and cause of death were recorded from disease onset. Cox's proportional hazards regression was used to identify important predictors for death and cardiovascular event during followup.
The standardized mortality ratio in both sexes was significantly higher (1.57) for all underlying causes together, for CVD (1.46) and for ischemic heart disease (IHD) (1.54) compared to the reference population. The death rate increased over time. In multiple Cox regression analyses, male sex, higher age at disease onset, and former cardiovascular event increased the death rate. Male sex, high age at disease onset, and hypertension increased the risk of cardiovascular event. Diabetes mellitus, treatment with corticosteroids, DMARD, or HRT did not influence the risks of death or first cardiovascular event.
The overall mortality and death due to CVD and IHD were in both sexes increased in seropositive RA. Male sex and high age at disease onset predicted death and cardiovascular event. Except for hypertension, which increased the risk for cardiovascular event, neither of these traditional cardiovascular risk factors nor corticosteroid treatment influenced mortality by all causes or by cardiovascular event.
调查瑞典北部类风湿关节炎（RA）患者的全因死亡率和心血管死亡率。分析传统危险因素以及与类风湿疾病及其治疗相关的因素对心血管疾病（CVD）进展和全因死亡率的影响。
对606例血清学阳性的RA患者进行队列研究，随访时间从1979年至1994年底或直至患者死亡。以韦斯特博滕的人群作为对照，估计标准化死亡率和生存曲线。记录从疾病发作起的性别、发病年龄、皮质类固醇治疗、使用改善病情抗风湿药物（DMARD）和激素替代疗法（HRT）、高血压、糖尿病、HLA类型以及死亡原因。采用Cox比例风险回归来确定随访期间死亡和心血管事件的重要预测因素。
与对照人群相比，男女全因、CVD和缺血性心脏病（IHD）的标准化死亡率均显著更高（分别为1.57、1.46和1.54）。死亡率随时间增加。在多因素Cox回归分析中，男性、发病年龄较大以及既往有心血管事件会增加死亡率。男性、发病年龄较大和高血压会增加心血管事件风险。糖尿病、皮质类固醇、DMARD或HRT治疗不影响死亡风险或首次心血管事件风险。
血清学阳性的RA患者中，男女的全因死亡率以及CVD和IHD导致的死亡率均升高。男性和发病年龄较大可预测死亡和心血管事件。除高血压会增加心血管事件风险外，这些传统心血管危险因素和皮质类固醇治疗均不影响全因死亡率或心血管事件导致的死亡率。
