Abstract
We aimed to investigate the prescribing trend of antirheumatic drugs and assess the risk of cardiovascular disease in patients with rheumatoid arthritis in Taiwan. This study was a retrospective cohort study, conducted based on the Taiwan National Health Insurance Research Database. The study subjects were 15,366 new rheumatoid arthritis patients from 2003 to 2010. To avoid selection bias, we applied propensity score matching to obtain general patients, as the control group. Cox proportional hazard model was used to evaluate the risk of cardiovascular disease in rheumatoid arthritis patients. The most common prescriptions of rheumatoid arthritis were nonsteroidal anti-inflammatory drugs. After controlling for related variables, rheumatoid arthritis patients had a higher risk of cardiovascular disease than general patients (adjusted hazard ratio [aHR] = 1.31; 95% confidence interval [CI]: 1.23-1.39). Age was the most significantly associated risk factor with the cardiovascular disease. Other observed risk factors for cardiovascular disease included hypertension (aHR = 1.57, 95% CI: 1.48-1.65), diabetes mellitus (aHR = 1.47, 95% CI: 1.38-1.57), and chronic kidney disease (aHR = 1.48, 95% CI: 1.31-1.66). Patients with rheumatoid arthritis indeed had a higher risk of incident cardiovascular diseases. Besides, age, hypertension, diabetes mellitus, and chronic kidney disease were also associated with a higher risk of cardiovascular disease.
Highlights
Patients with rheumatoid arthritis (RA) have 2-5 times increased the risk of premature cardiovascular disease (CVD), which shortens their life expectancy by 5-10 years [1]
This nationwide retrospective cohort study was based on the data from Longitudinal Health Insurance Database (LHID), which was randomly selected from the National Health Insurance Research Database (NHIRD) provided by the National Health Insurance Administration, Ministry of Health and Welfare, and managed by National Health Research Institutes (Registered number NHIRD-104-004)
The age was the greatest risk factors contributing to the occurrence of incident CVD
Summary
Patients with rheumatoid arthritis (RA) have 2-5 times increased the risk of premature cardiovascular disease (CVD), which shortens their life expectancy by 5-10 years [1]. Common proinflammatory cytokines are involved in the development and progression of both RA and atherosclerosis. Proinflammatory cytokines, such as interleukin- (IL-) 1, IL-6, and tumor necrosis factor-alpha (TNF-α), produced within locally affected joints in RA may promote both traditional [e.g., dyslipidemia and insulin resistance (IR)] and nontraditional (e.g., oxidative stress) systemic cardiovascular risk factors [2]. RA patients are less likely to report symptoms of angina and more likely to experience unrecognized myocardial infarction (MI) and sudden cardiac death [3].
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