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Rheumatoid Arthritis Clinical Studies
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The risk of myocardial infarction and pharmacologic and nonpharmacologic myocardial infarction predictors in rheumatoid arthritis: A cohort and nested case–control analysis†
Article first published online: 29 AUG 2008
DOI: 10.1002/art.23811
Copyright © 2008 by the American College of Rheumatology
Additional Information
How to Cite
Wolfe, F. and Michaud, K. (2008), The risk of myocardial infarction and pharmacologic and nonpharmacologic myocardial infarction predictors in rheumatoid arthritis: A cohort and nested case–control analysis. Arthritis & Rheumatism, 58: 2612–2621. doi: 10.1002/art.23811
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Publication History
- Issue published online: 29 AUG 2008
- Article first published online: 29 AUG 2008
- Manuscript Accepted: 29 MAY 2008
- Manuscript Received: 27 AUG 2007
Funded by
- Abbott
- Amgen
- Wyeth-Australia
- Merck
- Pfizer
- Abstract
- Article
- References
- Cited By
Abstract
Objective
To determine the risk of myocardial infarction (MI) in patients with rheumatoid arthritis (RA) compared with that in patients with noninflammatory rheumatic disorders and to determine risk factors for MI in RA, the relationship between cardiovascular risk factors and corticosteroid use, and the relationship between RA treatment and MI.
Methods
We conducted a cohort study of MI in 17,738 patients with RA and 3,001 patients with noninflammatory rheumatic disorders who were assessed at 6-month intervals between 1999 and July 2006. We evaluated treatment effect in a nested case–control study of RA participants who were matched by age, sex, study duration, and date of study entry.
Results
The covariate-adjusted risk of first MI in RA versus that in noninflammatory rheumatic disorders was 1.9 (95% confidence interval 1.2–2.9) (P = 0.005). In RA, MI was predicted by age, sex, education level, hypertension, smoking, exercise, prior MI, diabetes, a comorbidity index, use of low-dose aspirin and antilipemic agents, RA severity and treatment variables, and corticosteroid use. Except for obesity, predictors were of equal strength in RA and noninflammatory rheumatic disorders. The increased risk for MI in RA compared with that in noninflammatory rheumatic disorders lessened when corticosteroid users were excluded. Use of corticosteroids was associated with future development of diabetes and hypertension.
Conclusion
MI in RA is associated with demographic and cardiovascular risk factors and corticosteroid use. Study data support the hypothesis that RA activity causes MI and that corticosteroids are primarily a marker of RA activity. However, corticosteroids increase the risk of diabetes and hypertension and contribute to the overall risk of MI.