Abstract
ObjectivesTo determine whether anti-rheumatic drug usage is associated with risk of coronary artery diseases (CAD) in incident Rheumatoid Arthritis (RA) patients.MethodsData were obtained from the Taiwan National Health Insurance Research Database. The study cohort comprised 6260 patients who were newly diagnosed with RA between 2001–2010. The study endpoint was occurrence of CAD according to the ICD-9-CM codes. We used the WHO Defined Daily Dose (DDD) as a tool to assess the drugs exposure. The Cox proportional hazards regression model was used to estimate the hazard ratio (HR) of disease after controlling for demographic and other co-morbidities. When the proportionality assumption is violated, a spline curve of the Scaled Schoenfeld residuals is fitted to demonstrate the estimated effect on CAD over time for drug usage.ResultsAmong RA patients, use of celecoxib, and etoricoxib was associated with significantly decreased incidence of CAD. The adjusted HR(95% CI) of CAD for low-dose celecoxib (DDD≦1) and high-dose user were 0.47(0.34, 0.65) and 0.37(0.24, 0.58) during the 4 year follow-up time; however, it became 0.98(0.70, 1.37) and1.29(0.85, 1.95). Adjusted HR(95% CI) of CAD for etoricoxib users remained 0.47(0.26, 0.84).ConclusionsThis study revealed association of decreased CAD risk in RA patients taking 2 different kinds of COX-2i in comparison with nonusers. The effect might be changed over time, after about 4 years.
Highlights
Rheumatoid arthritis (RA) is a common and destructive chronic systemic inflammatory disease with the average age-adjusted annual incidence rate 15.8 per 100,000 in Taiwan[1,2]
Among RA patients, use of celecoxib, and etoricoxib was associated with significantly decreased incidence of coronary artery diseases (CAD)
This study revealed association of decreased CAD risk in RA patients taking 2 different kinds of cyclooxygenase 2 inhibitors (COX-2i) in comparison with nonusers
Summary
Rheumatoid arthritis (RA) is a common and destructive chronic systemic inflammatory disease with the average age-adjusted annual incidence rate 15.8 per 100,000 in Taiwan[1,2]. Over the past few years, there has been mounting evidence of a series of factors related to inflammation which explain accelerated CVD in RA[12,13].Both traditional Framingham risk factors and such risk factors unique to those with systemic inflammatory disorders may have contributed to CAD risk in RA patients[6,14,15,16]. To clarify this phenomenon, some postulated that anti-rheumatic medications appear to modify the risk of CVD in RA[17]. A case-control analysis within a cohort of subjects with RA, observed between 1999 and 2003 showed that risk of acute myocardial infarction was not related with cyclooxygenase 2 inhibitors (COX-2i) usage (rate ratio 1.11, 95% confidence interval 0.87–1.43) [20]
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