Cardiovascular Morbidity and Mortality in Women Diagnosed With Rheumatoid Arthritis

Background—Rheumatoid arthritis may be associated with an increased risk of cardiovascular disease. We compared the incidence rates of myocardial infarction and stroke in subjects with and without rheumatoid arthritis. Methods and Results—A prospective cohort study was conducted among the 114 342 women participating in the Nurses’ Health Study who were free of cardiovascular disease and rheumatoid arthritis at baseline in 1976. All self-reported cases of rheumatoid arthritis were confirmed by medical record review. Fatal and nonfatal myocardial infarctions and strokes were similarly confirmed. Multivariate pooled logistic regression was used to adjust for potential cardiovascular risk factors. Five hundred twenty-seven incident cases of rheumatoid arthritis and 3622 myocardial infarctions and strokes were confirmed during 2.4 million person-years of follow-up. The adjusted relative risk of myocardial infarction in women with rheumatoid arthritis compared with those without was 2.0 (95% confidence interval [CI], 1.23 to 3.29). For stroke, the adjusted relative risk was 1.48 (95% CI, 0.70 to 3.12). Women who had rheumatoid arthritis for at least 10 years had a risk for myocardial infarction of 3.10 (95% CI, 1.64 to 5.87). Conclusion—In this large prospective cohort of women, participants with rheumatoid arthritis had a significantly increased risk of myocardial infarction but not stroke compared with those without rheumatoid arthritis. If these data are confirmed, aggressive coronary heart disease prevention strategies should be tested for persons with rheumatoid arthritis.

[1]  R. Monson,et al.  Mortality among arthritics. , 1976, Journal of chronic diseases.

[2]  P. Allebeck.  Increased mortality in rheumatoid arthritis. , 1982, Scandinavian journal of rheumatology.

[3]  M. Petri.  Biochemical characterization of ADP-ribose polymer metabolism in SLE. , 1996 .

[4]  W. Willett,et al.  Test of the National Death Index. , 1984, American journal of epidemiology.

[5]  C. Werning.  [Rheumatoid arthritis]. , 1983, Medizinische Monatsschrift fur Pharmazeuten.

[6]  G L Freeman,et al.  High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. , 2001, Arthritis and rheumatism.

[7]  P. Ridker,et al.  Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. , 1998, Circulation.

[8]  Thomas G. Whiston,et al.  A National Survey , 1992 .

[9]  D. Symmons.  Mortality in rheumatoid arthritis. , 1988, British journal of rheumatology.

[10]  P. Ridker,et al.  Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. , 1997, The New England journal of medicine.

[11]  F. D. Weinfeld,et al.  The National Survey of Stroke. Clinical findings. , 1981, Stroke.

[12]  R. Ross,et al.  Atherosclerosis is an inflammatory disease. , 1998, American heart journal.

[13]  C. Helmick,et al.  Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. , 1998, Arthritis and rheumatism.

[14]  A. Rebuzzi,et al.  The prognostic value of C-reactive protein and serum amyloid a protein in severe unstable angina. , 1994, The New England journal of medicine.

[15]  CLINICAL FINDINGS , 1978, WHO regional publications. European series.

[16]  R B D'Agostino,et al.  Relation of pooled logistic regression to time dependent Cox regression analysis: the Framingham Heart Study. , 1990, Statistics in medicine.

[17]  H. Blackburn,et al.  Cardiovascular survey methods. , 1969, Monograph series. World Health Organization.

[18]  J. Sánchez-Guerrero,et al.  A connective tissue disease screening questionnaire for population studies. , 1995, Annals of epidemiology.

[19]  F. Speizer,et al.  The Nurses' Health Study , 1978, The American journal of nursing.

[20]  G. Alarcón,et al.  Folic acid supplementation prevents deficient blood folate levels and hyperhomocysteinemia during longterm, low dose methotrexate therapy for rheumatoid arthritis: implications for cardiovascular disease prevention. , 1998, The Journal of rheumatology.

[21]  S. Cobb,et al.  Length of life and cause of death in rheumatoid arthritis. , 1953, The New England journal of medicine.

[22]  D. Nashel.  Is atherosclerosis a complication of long-term corticosteroid treatment? , 1986, The American journal of medicine.

[23]  Lise,et al.  Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. , 2000, The New England journal of medicine.

[24]  R. Frye,et al.  T-cell immunity in acute coronary syndromes. , 2001, Mayo Clinic proceedings.

[25]  J. Manson,et al.  The Nurses' Health Study: 20-year contribution to the understanding of health among women. , 1997, Journal of women's health.

[26]  R. Frye,et al.  Monoclonal T-cell proliferation and plaque instability in acute coronary syndromes. , 2000, Circulation.

[27]  M. Liang,et al.  The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. , 1988, Arthritis and rheumatism.

[28]  M. Petri,et al.  Hydroxychloroquine use in the Baltimore Lupus Cohort: effects on lipids, glucose and thrombosis. , 1996, Lupus.

[29]  D. Wallace,et al.  Cholesterol-lowering effect of hydroxychloroquine in patients with rheumatic disease: reversal of deleterious effects of steroids on lipids. , 1990, The American journal of medicine.

[30]  D. Redelmeier,et al.  The treatment of unrelated disorders in patients with chronic medical diseases. , 1998, The New England journal of medicine.

[31]  S. R. Dahlqvist,et al.  Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in Northern Sweden. , 1997, The Journal of rheumatology.

[32]  P. Allebeck.  Increased Mortality in Rheumatoid Arthritis: The Use of a Medical Information System for Assessment of Death Risks , 1982 .

[33]  James M Robins,et al.  Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study , 2002, The Lancet.

[34]  H. Kautiainen,et al.  Cardiovascular mortality in women with rheumatoid arthritis. , 1995, The Journal of rheumatology.

[35]  P. Shekelle,et al.  Quality of care for patients with rheumatoid arthritis. , 2000, JAMA.

[36]  T. Pincus,et al.  Severe functional declines, work disability, and increased mortality in seventy-five rheumatoid arthritis patients studied over nine years. , 1984, Arthritis and rheumatism.