TY - JOUR
T1 - Improved incidence of cardiovascular disease in patients with incident rheumatoid arthritis in the 2000s
T2 - A population-based cohort study
AU - Myasoedova, Elena
AU - Davis, John M.
AU - Roger, Veronique L.
AU - Achenbach, Sara J.
AU - Crowson, Cynthia S.
N1 - Funding Information:
This work was supported by a grant from the National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01 AR46849), National Heart, Lung, and Blood Institute (HL120859), and the National Institute of Aging (R01 AG068192, R01 AG034676. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. EM is supported by the Louis V. Gerstner, Jr. Fund at Vanguard Charitable. 1E. Myasoedova, MD, PhD, Division of Rheumatology, Department of Internal Medicine, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic; 2J.M. Davis III, MD, MS, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic; 3V.L. Roger, MD, MPH, Division of Epidemiology, Department of Health Sciences Research, and Division of Circulatory Failure, Department of Cardiovascular Disease, Mayo Clinic; 4S.J. Achenbach, MS, Division of Medical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic; 5C.S. Crowson, PhD, Division of Rheumatology, Department of Internal Medicine, and Division of Medical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA. The authors declare no conflict of interest relevant to this article. Address correspondence to Dr. E. Myasoedova, Mayo Clinic College of Medicine and Science, Division of Rheumatology, 200 1st St. SW, Rochester, MN 55905, USA. Email: myasoedova.elena@mayo.edu. Accepted for publication January 29, 2021.
Publisher Copyright:
© 2021 The Journal of Rheumatology. This is an Open Access article, which permits use, distribution, and reproduction, without modification, provided the original article is correctly cited and is not used for commercial purposes.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Objective. To assess trends in incidence of cardiovascular disease (CVD) and mortality following incident CVD events in patients with rheumatoid arthritis (RA) onset in 1980-2009 vs non-RA subjects. Methods. We studied Olmsted County, Minnesota residents with incident RA (aged > 18 yrs, 1987 American College of Rheumatology criteria met in 1980-2009) and non-RA subjects from the same source population with similar age, sex, and calendar year of index. All subjects were followed until death, migration, or December 31, 2016. Incident CVD events included myocardial infarction and stroke. Patients with CVD before RA incidence/index date were excluded. Cox models were used to compare incident CVD events by decade, adjusting for age, sex, and CVD risk factors. Results. The study included 905 patients with RA and 904 non-RA subjects. Cumulative incidence of any CVD event was lower in patients with incident RA in the 2000s vs the 1980s. The HR for any incident CVD in the 2000s vs 1980s was 0.53 (95% CI 0.31-0.93). The strength of association attenuated after adjustment for anti-rheumatic medication use (HR 0.64, 95% CI 0.34-1.22). Patients with RA in the 2000s had no excess in CVD over non-RA subjects (HR 0.71, 95% CI 0.42-1.19). Risk of death after a CVD event was somewhat lower in patients with RA after the 1980s with an HR of 0.54 (95% CI 0.33-0.90) in the 1990s vs 1980s and 0.68 (95% CI 0.33-1.41) in the 2000s vs 1980s. Conclusion. The incidence of major CVD events in RA has declined in recent decades. The gap in CVD occurrence between patients with RA and the general population is closing. Mortality after CVD events in RA may be improving.
AB - Objective. To assess trends in incidence of cardiovascular disease (CVD) and mortality following incident CVD events in patients with rheumatoid arthritis (RA) onset in 1980-2009 vs non-RA subjects. Methods. We studied Olmsted County, Minnesota residents with incident RA (aged > 18 yrs, 1987 American College of Rheumatology criteria met in 1980-2009) and non-RA subjects from the same source population with similar age, sex, and calendar year of index. All subjects were followed until death, migration, or December 31, 2016. Incident CVD events included myocardial infarction and stroke. Patients with CVD before RA incidence/index date were excluded. Cox models were used to compare incident CVD events by decade, adjusting for age, sex, and CVD risk factors. Results. The study included 905 patients with RA and 904 non-RA subjects. Cumulative incidence of any CVD event was lower in patients with incident RA in the 2000s vs the 1980s. The HR for any incident CVD in the 2000s vs 1980s was 0.53 (95% CI 0.31-0.93). The strength of association attenuated after adjustment for anti-rheumatic medication use (HR 0.64, 95% CI 0.34-1.22). Patients with RA in the 2000s had no excess in CVD over non-RA subjects (HR 0.71, 95% CI 0.42-1.19). Risk of death after a CVD event was somewhat lower in patients with RA after the 1980s with an HR of 0.54 (95% CI 0.33-0.90) in the 1990s vs 1980s and 0.68 (95% CI 0.33-1.41) in the 2000s vs 1980s. Conclusion. The incidence of major CVD events in RA has declined in recent decades. The gap in CVD occurrence between patients with RA and the general population is closing. Mortality after CVD events in RA may be improving.
KW - Cardiovascular diseases
KW - Epidemiology
KW - Rheumatoid arthritis
UR - http://www.scopus.com/inward/record.url?scp=85114319485&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85114319485&partnerID=8YFLogxK
U2 - 10.3899/jrheum.200842
DO - 10.3899/jrheum.200842
M3 - Article
C2 - 33589553
AN - SCOPUS:85114319485
SN - 0315-162X
VL - 48
SP - 1379
EP - 1387
JO - Journal of Rheumatology
JF - Journal of Rheumatology
IS - 9
ER -