Abstract
Purpose
To examine whether the risk of cardiovascular disease (heart failure (HF), ischemic heart disease (IHD), myocardial infarction (MI), and coronary revascularization) in patients with rheumatoid arthritis (RA) is comparable to the risk in patients with diabetes mellitus (DM) and general population.
Methods
The study included the entire Danish population encompassing about 5.7 million inhabitants. Through individual record linkage of nationwide administrative health registries, the authors identified subjects who developed RA and DM and compared these to a matched general population. The cohorts were followed from 1 January 1995 until December 2016.
Results
The study population consisted of a cohort of 15,491 RA patients, 309,698 DM patients, and a general population cohort of 77,455 subjects matched by age, sex, and year of diagnosis with the RA cohort.
Cumulative incidence for HF, IHD, MI, PCI (percutaneous coronary intervention) and CABG (coronary artery bypass grafting) are shown in figure 1.
The adjusted hazard ratio (HR) for diagnosis of HF within the 10-year observational period for RA (1.46; 95% CI 1.34–1.59) and DM (1.86; 95% CI 1.78–1.95) were increased compared to the general population. Comparing the risk of HF within the follow-up period a 21% relative risk (HR 0.79, 95% CI 0.73–0.85) reduction of HF in RA compared to DM patients was observed.
The HR for IHD development during the follow-up period for RA (1.36; 95% CI 1.25–1.48) and DM (1.64; 95% CI 1.58–1.72) were increased compared to control group. Comparing the risk of IHD within the follow-up period a 17% relative risk (HR 0.83, 95% CI 0.77–0.89) reduction for IHD development in RA compared to DM patients. The HR for MI was increased both in RA (1.48; 95% CI 1.34–1.63) and DM (1.57; 95% CI 1.49–1.65) compared to the control group, without any statistical difference within RA and DM. According to the coronary revascularization, comparable increased numbers of PCI were observed in RA (1.37; 95% CI 1.22–1.54) and DM (1.50; 95% CI 1.41–1.59) patients compared to control subjects. Interestingly, the HR of coronary by-pass grafting (CABG) for RA (1.20; 95% CI 0.98–1.49) and DM (1.99; 95% CI 1.80–2.19) resulting in an adjusted 39% relative risk (0.61 95% CI 0.50–0.74) reduction for CABG in RA compared to DM patients.
Figure 1
Conclusions
Patients with RA are at increased risk of cardiovascular disease when compared to the general population although slightly lower than observed among patients with DM. Revascularization with CABG was only increased among DM patients, which likely reflects physician compliance to guidelines recommending CABG in case of multivessel disease among DM patients. Patients with RA should be considered for prophylactic strategies in the same way as recommended for patients with DM.
A Mixture Model Incorporating Individual Heterogeneity in Human Lifetimes
