THU0124 FACTORS ASSOCIATED WITH THE RISK OF MAJOR ADVERSE CARDIOVASCULAR EVENT IN PATIENTS WITH RHEUMATOID ARTHRITIS: A NATIONWIDE, POPULATION-BASED, CASE-CONTROL STUDY

Abstract

Background:Few population-based studies have assessed factors associated with major adverse cardiovascular evet (MACE) among patients with rheumatoid arthritis (RA).Objectives:The study aimed to assess risk factors of MACE in RA patients in Taiwan.Methods:This study used the 2003–2013 Taiwanese National Health Insurance Research Database to identify 115,143 newly-diagnosed RA patients aged 20 years or more from 2004 to 2012. MACE was defined as having an inpatient visit with a diagnosis of myocardial infarction (ICD-9-CM 410.x except 410.2) with the receipt of coronary artery bass graft or percutaneous coronary intervcention/percutaneous transluminal coronary angioplasty, or having an inpatient visit with a diagnosis of ischemic stroke (ICD-9-CM 433-436 except 433.0 and 434.0). We firstly identified 108,319 RA patients who had no history of MACE before RA diagnosis date. From these patients, we identified 7,580 RA patients who developed MACE in the follow-up period and 100,739 who did not develop MACE in the follow-up periods. The index dates for MACE cases were the date of first inpatient visit for MACE. We finally selected 5,994 MACE cases and 23,976non-MACE controls matching (1:4) for age, sex and disease duration. We examined the associations of MACE with comorbidities, use of biological and conventional synthetic disease modifying antirheumatic drugs (DMARDs), nonsteroidal anti-inflammation drug (NSAID), corticosteroid, antiplatelet agent, anticoagulant, statin and non-statin lipid lowering agents within one year before the index date using conditional logistic regression analyses with a full model and a parsinomious model (only considering the covariates with a p value <0.05 in the univarialbe analysis), shown as odds ratios (ORs) with 95% confidence intervals (CIs).Results:We selected 5,994 MACE cases and 23,976 non-MACE controls. The mean ± SD age was 69.19±11.62 years and 18,925 (63.15%) subjectes were female. The mean ± SD disease duration was 3.44±2.21 years. Using multivariable conditional logistic regression analysis, the risk of MACE was associated with use of abatacept (OR, 0.12; 95% CI, 0.02–0.90), methotrexate (OR, 0.69; 95% CI, 0.62–0.76), ciclosporin (OR, 1.41; 95% CI, 1.06–1.86), NSAID (OR, 1.36; 95% CI, 1.27–1.45), antiplatelet agent (OR, 2.48; 95% CI, 2.32–2.64), non-statin lipid lowering agents (OR, 1.46; 95% CI, 1.28–1.65), and comorbidities including hypertension (OR, 1.23; 95% CI, 1.16–1.32), diabetes (OR, 1.28; 95% CI, 1.19–1.38), ischemic heart disease (OR, 1.22; 95% CI, 1.12–1.33) and chronic obstructive pulmonary disease (COPD) (OR, 1.13; 95% CI, 1.04–1.24) in the parsinomious model.Conclusion:This population-based case-control study revealed that in newly-diagnosed RA patients, use of abatacept and methotrexate were associated with a decreased risk of MACE development, while use of ciclosporin, NSAID, antiplatelet agents and non-statin lipid lowering agents, and comorbidities including hypertension, diabetes, ischemic heart disease and COPD were associated with an increased risk of MACE development.