RA, diabetes confer same cardiovascular risk.
Further, the risk of MI in rheumatoid arthritis patients corresponds to that observed in the general population of individuals without the musculoskeletal condition who are, on average, 10 years older, and does not appear to be affected by the duration of drug treatment for the disease, Dr. Jesper Lindhardsen of Gentofte University Hospital in Copenhagen and colleagues reported.
Using nationwide registers comprising the entire Danish population older than 16 years, the researchers identified individuals with new-onset rheumatoid arthritis (RA), new-onset diabetes, and new MI during a 10-year period, excluding those with prior disease and incomplete data from the full cohort of 4,311,022 subjects.
During those 10 years, 9,921 individuals developed RA and 129,659 developed diabetes, the authors reported. Compared with the diabetes patients, "RA patients were more often women, used less cardioprotective medications, and had less comorbidity, whereas age was similar in the two groups," they wrote.
Regarding cardiovasoalar outcomes, 265 of the RA patients and 3,948 of the diabetes patients had new MI, representing in both cohorts a 1.7 increased incidence rate ratio (IRR) of MI in a fully adjusted model compared with the general population in which 75,870 individuals had new MIs. The IRR among patients with both RA and diabetes was 2.6, "which roughly equaled the predicted additive risk for the two separate diseases," they noted (Ann. Rheum. Dis. 2011;70:929-34).
The researchers conducted a nested case-control study that corroborated the comparable risk of MI in the RA and diabetes patients. The findings demonstrated that the increased risk in these groups was independent of treatment duration within the time frame of the current study, they wrote.
Stratified by gender, the MI risk estimates did not differ between women and men in the RA group. In the diabetes patients, however, women were at significantly higher risk than were men for the adverse cardiovascular outcome. An age-dependent pattern of MI risk was also observed. Among women with RA and diabetes, respectively, the risk of MI in those younger than 50 years was 5.5 and 5.9 times that observed in the age-matched reference group, they reported. For women between 50 and 65 years of age, the IRRs were 1.7 and 2.6 for RA and diabetes patients, respectively.
The age-stratified patterns in men were different, the authors stated, noting that "the IRRs in the two oldest age groups were comparable, and even tended to be slightly higher in the 50- to 65years age group of RA patients compared with the same-age [diabetes] patients." And while the youngest men with RA had a markedly raised IRR, diabetes patients in the same age stratum had a significantly higher risk, with an IRR of 4.9 compared with 2.1, they said.
In a fully adjusted regression model in which the IRRs for MI in RA patients were calculated according to 10-year subject age intervals, "RA patients had the same, or higher, risk of MI as control subjects who were, on average, 10 years older," the authors reported.
Despite several study limitations, "the results corroborate and expand previous findings in this area of research and indicate that patients with RA should be considered for more aggressive primary [cardiovascular disease] prevention," the authors stressed.
The study was sponsored by the Danish Rheumatism Association. The authors reported having no disclosures.
BY DIANA MAHONEY
FROM ANNALS OF THE RHEUMATIC DISEASES
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|Title Annotation:||MUSCULOSKELETAL DISORDERS|
|Publication:||Family Practice News|
|Date:||Jun 15, 2011|
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