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Increased incidence of and impaired prognosis after acute myocardial infarction among patients with seropositive rheumatoid arthritis.
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Reumatology.
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
Department of Medicine, Kalix Hospital, Kalix, Sweden .
Umeå University, Faculty of Social Sciences, Department of Statistics.
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2007 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, 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. Vol. 66, no 2, 263-266 p.
Keyword [en]
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: urn:nbn:se:umu:diva-16356DOI: 10.1136/ard.2006.052456PubMedID: 16854951OAI: oai:DiVA.org:umu-16356DiVA: diva2:156029
Available from: 2008-01-13 Created: 2008-01-13 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Epidemiological and pathogenic aspects on cardiovascular disease in rheumatoid arthritis
Open this publication in new window or tab >>Epidemiological and pathogenic aspects on cardiovascular disease in rheumatoid arthritis
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
Rheumatoid arthritis, cardiovascular disease, myocardial infarction, stroke, atherosclerosis, intima media thicknes, flow mediated dilatation, endothelial activation, mortality, morbidity
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-1906 (URN)978-91-7264-656-8 (ISBN)
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

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