Abstract
Objectives: Rheumatoid arthritis (RA) is an independent nontraditional risk factor for incidence of myocardial infarction (MI) and post-MI outcome is impaired in the RA population. Use of beta-blockers improves the long-term survival after MI in the general population while the protective effect of beta-blockers in RA patients is not clear. We investigate the impact of beta-blockers on the long-term outcome of MI among RA patients.Methods: We identified RA subjects from the registries for catastrophic illness and myocardial infarction from 2003 to 2013. The enrolled subjects were divided into three groups according to the prescription of beta-blockers (non-user, non-selective, and β1-selective beta-blockers). The primary endpoint was all-cause mortality. We adjusted clinical variables and utilized propensity scores to balance confounding bias. Cox proportional hazards regression models were used to estimate the incidence of mortality in different groups.Results: A total of 1,292 RA patients with myocardial infarction were enrolled, where 424 (32.8%), 281 (21.7%), and 587 (45.5%) subjects used non-user, non-selective, and β1-selective beta-blockers, respectively. Use of beta-blockers was associated with lower risk of all-cause mortality after adjustment with comorbidities, medications (adjusted hazard ratio [HR] 0.871; 95% confidence interval [CI] 0.727–0.978), and propensity score (HR 0.882; 95% CI 0.724–0.982). Compared with β1-selective beta-blockers, treatment with non-selective beta-blockers (HR 0.856; 95% CI 0.702–0.984) was significantly related to lower risk of mortality. The protective effect of non-selective beta-blockers remained in different subgroups including sex and different anti-inflammatory drugs.Conclusion: Use of beta-blockers improved prognosis in post-MI patients with RA. Treatment with non-selective beta-blockers was significantly associated with reduced risk of mortality in RA patients after MI rather than β1-selective beta-blockers.
Highlights
Rheumatoid arthritis (RA) is the most common inflammatory arthritis with symmetric polyarticular involvement (Firestein, 2003)
Among the non-selective betablockers group, 1.4, 0.7, 1.7, 11, 8.5, and 76.7% of patients were prescribed with pindolol, alprenolol, nadolol, carvedilol, TABLE 1 | Incidence of mortality by prescriptions
We found that treatment with non-selective beta-blockers was associated with an even lower risk of mortality in RA patients after myocardial infarction (MI), compared with use of β1-selective betablockers
Summary
Rheumatoid arthritis (RA) is the most common inflammatory arthritis with symmetric polyarticular involvement (Firestein, 2003). People who have had RA for at least 10 years have around a three-fold higher risk for myocardial infarction compared with the general population (Sattar and Mcinnes, 2005). Cardiovascular mortality was 50% higher in RA patients than in the general population, and ischemia heart disease (IHD) increased mortality risks by 59%, compared with non-RA people (Avina-Zubieta et al, 2008). These findings implied that RA disease activity and systemic inflammation are key elements underlying increased atherosclerotic burden and premature atherosclerosis (Choy et al, 2014; Sparks, 2019). The potential mechanism of MI in RA patients is that acute phase reactants drive synovial inflammation which raising circulating cytokines, like interleukin-6 or leptin, leading to a spectrum of proatherogenic changes and endothelial dysfunction and damage (Sattar and Mcinnes, 2005)
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