umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Epidemiological and pathogenic aspects on cardiovascular disease in rheumatoid arthritis
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Reumatology.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Rheumatoid arthritis (RA) is a chronic disabling disease that is associated with a shortened life span. Cardiovascular disease (CVD) contributes to this increased mortality, and also to a great extent to the co-morbidity observed in patients with RA. This thesis aimed to investigate these issues further.

The incidence of, and prognosis after an acute myocardial infarction (AMI) /or stroke in a cohort of RA patients was compared with that in the general population within the northern Sweden MONICA register. The standard incidence ratio (SIR) for AMI was 2.9 and for stroke 2.7 in RA patients compared with the general population (p<0.05 for both). During the first 10 years following an event, RA patients had a higher overall case fatality (CF) compared with controls (HR for AMI=1.67, 95%CI [1.02, 2.71], HR for stroke=1.65, 95%CI [1.03, 2.66]).

An elevated level of homocysteine is regarded to be a risk marker for CVD. The effects of treatment with B vitamins on the homocysteine level in patients with RA were studied in a consecutive cohort of patients with RA. Sixty-two patients with RA having a homocysteine level of 12 mol were randomized to receive either a placebo or a combination of the vitamins B6, B12 and folic acid. The patients were treated and evaluated in a double-blind manner over 12 months. The homocysteine level was found to be significantly decreased in the B-vitamin treated patients compared with the placebo group (p<0.0001).

To evaluate the progression of sub-clinical atherosclerosis in patients with very early RA compared with controls, all patients from the three most northern counties of Sweden newly diagnosed with RA and aged ≤60 years were consecutively recruited. Age and sex matched controls from the general population were also included. Intima media thickness (IMT) of the common carotid artery and endothelium dependent flow mediated dilation (ED-FMD) of the brachial artery were measured using ultrasonography. After 18 months the same measurements were undertaken in a sub-group of the patients with early RA and the relevant controls. There were no differences between patients with early RA and controls in terms of IMT or ED-FMD at inclusion into the study. However, after 18 months there was a significant increase in the IMT among the patients with early RA (p<0.05); no such increase occurred in the control group.

Biomarkers of endothelial activation that may reflect the early atherosclerosis that occurs in RA were also evaluated. At inclusion, both IMT and ED-FMD among the patients with early RA related significantly to several of the biomarkers of endothelial activation. Furthermore, markers of inflammation (e.g., DAS28) were significantly related to biomarkers of endothelial activation.

In conclusion, RA patients had a higher incidence of CVD and a higher CF after a CV event. The increased homocysteine level among patients with RA was as easy to decrease as in the general population. At the time of diagnosis of RA there were no differences in atherosclerosis between patients and controls, however the patients with RA had a more rapid progression of atherosclerosis than the control subjects. Moreover, there were implications of endothelial activation already in patients with very early RA. Taken together, these results emphasize the necessity of optimizing the preventive, diagnostic and caring strategies for CVD in patients with RA.

Place, publisher, year, edition, pages
Umeå: Reumatologi , 2008.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1215
Keyword [en]
Rheumatoid arthritis, cardiovascular disease, myocardial infarction, stroke, atherosclerosis, intima media thicknes, flow mediated dilatation, endothelial activation, mortality, morbidity
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-1906ISBN: 978-91-7264-656-8 (print)OAI: oai:DiVA.org:umu-1906DiVA: diva2:142370
Public defence
2008-11-21, sal B, 1D, 9 tr, NUS, Umeå, 13:00 (English)
Opponent
Available from: 2008-11-07 Created: 2008-11-07 Last updated: 2010-04-10Bibliographically approved
List of papers
1. Increased incidence of and impaired prognosis after acute myocardial infarction among patients with seropositive rheumatoid arthritis.
Open this publication in new window or tab >>Increased incidence of and impaired prognosis after acute myocardial infarction among patients with seropositive rheumatoid arthritis.
Show others...
2007 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, ISSN Online ISSN 1468-2060, Vol. 66, no 2, 263-266 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To examine the incidence and outcome of acute myocardial infarction (AMI) in patients with rheumatoid arthritis compared with the general population, and to examine whether care and treatment of an AMI differs between patients and controls.

Methods: The Multinational Monitoring of Trends and Determinants of Cardiovascular Disease register for northern Sweden was used to compare those incidences of AMI in a cohort of patients with rheumatoid arthritis with that in the general population. 35 patients with rheumatoid arthritis who had also experienced an AMI were identified. For each patient with rheumatoid arthritis, three controls with a history of AMI but without rheumatoid arthritis were randomly selected from the same register, and matched for age, sex and year of the AMI for evaluation of case fatality and potential differences in treatment of AMI.

Results: The standardised incidence ratio for AMI was 2.9 in patients with rheumatoid arthritis compared with the general population (p<0.05). During the first 10 years after an AMI, patients with rheumatoid arthritis had a higher overall case fatality compared with controls (hazard ratio (HR) 1.67, 95% confidence interval (CI) 1.02 to 2.71). Survival time was decreased in the rheumatoid arthritis group compared with controls despite the same care and treatment.

Conclusion: Both the incidence of and case fatality after an AMI were higher among patients with rheumatoid arthritis than among the general population. The results emphasise the necessity of optimising the preventive, diagnostic and caring strategies for AMI in rheumatoid arthritis.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd & European League Against Rheumatism, 2007
Keyword
Arthritis, Rheumatoid/*complications/immunology/mortality, Case-Control Studies, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Myocardial Infarction/*complications/immunology/mortality, Prognosis, Proportional Hazards Models, Serologic Tests, Time Factors
Identifiers
urn:nbn:se:umu:diva-16356 (URN)10.1136/ard.2006.052456 (DOI)16854951 (PubMedID)
Available from: 2008-01-13 Created: 2008-01-13 Last updated: 2010-03-10Bibliographically approved
2. Increased incidence of stroke and impaired prognosis after stroke among patients with seropositive rheumatoid arthritis
Open this publication in new window or tab >>Increased incidence of stroke and impaired prognosis after stroke among patients with seropositive rheumatoid arthritis
2009 (English)In: Clinical and Experimental Rheumatology, ISSN 0392-856X, E-ISSN 1593-098X, Vol. 27, no 4, 641-644 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To examine the incidence of, and outcome after, a stroke in patients with rheumatoid arthritis (RA) compared with the general population. METHODS: The northern Sweden MONICA register was used to compare the incidence of stroke in a cohort of RA patients with the general population. Forty RA patients who had also suffered a stroke were identified. For each patient with RA, three controls with a history of stroke but without RA were randomly collected from the same register, and matched for age and sex. RESULTS: The standardised incidence ratio (SIR) for stroke was 2.7 in RA patients compared with the general population (p<0.05). During the follow-up, RA patients had a higher overall case fatality (CF) following stroke compared with controls (hazard ratio (HR) =1.70, p<0.05). CONCLUSIONS: Both the incidence of a stroke, and the subsequent CF, were higher among RA patients compared with the general population. The results emphasize the necessity of optimising the prevention of stroke and follow-up care after a stroke in RA.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-32403 (URN)19772797 (PubMedID)
Available from: 2010-03-11 Created: 2010-03-11 Last updated: 2017-12-12Bibliographically approved
3. Homocysteine in patients with rheumatoid arthritis in relation to inflammation and B-vitamin treatment
Open this publication in new window or tab >>Homocysteine in patients with rheumatoid arthritis in relation to inflammation and B-vitamin treatment
2003 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, Vol. 32, no 4, 205-210 p.Article in journal (Refereed) Published
Identifiers
urn:nbn:se:umu:diva-3590 (URN)
Available from: 2008-11-07 Created: 2008-11-07 Last updated: 2013-03-19Bibliographically approved
4. No signs of premature atherosclerosis in early rheumatoid arthritis albeit endothelial biomarkers are upregulated
Open this publication in new window or tab >>No signs of premature atherosclerosis in early rheumatoid arthritis albeit endothelial biomarkers are upregulated
Show others...
(English)Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:umu:diva-3591 (URN)
Available from: 2008-11-07 Created: 2008-11-07 Last updated: 2011-01-18Bibliographically approved
5. Significant Increase of intima media thickness in eighteen months among patients with newly diagnosed rheumatoid arthritis
Open this publication in new window or tab >>Significant Increase of intima media thickness in eighteen months among patients with newly diagnosed rheumatoid arthritis
Show others...
(English)Article in journal (Refereed) Submitted
Identifiers
urn:nbn:se:umu:diva-3592 (URN)
Available from: 2008-11-07 Created: 2008-11-07 Last updated: 2011-01-18Bibliographically approved

Open Access in DiVA

fulltext(1619 kB)1107 downloads
File information
File name FULLTEXT01.pdfFile size 1619 kBChecksum SHA-1
297f92945c93eede481391be629c6e8df8083db80853a3e02d131aa23acecbfcef24b9b3
Type fulltextMimetype application/pdf

By organisation
Reumatology

Search outside of DiVA

GoogleGoogle Scholar
Total: 1107 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 480 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf