Circulation. 2003;107:1303-1307
Published online before print February 17, 2003, doi: 10.1161/01.CIR.0000054612.26458.B2
Published online before print February 17, 2003, doi: 10.1161/01.CIR.0000054612.26458.B2
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(Circulation. 2003;107:1303.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Cardiovascular Morbidity and Mortality in Women Diagnosed With Rheumatoid Arthritis
From the Division of Pharmacoepidemiology and Pharmacoeconomics (D.H.S.), Division of Rheumatology, Immunology, and Allergy (D.H.S., E.W.K., L.A.M.), and Division of Preventive Medicine, Channing Laboratory (J.E.M., M.J.S., G.C.C.); Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; Department of Epidemiology (E.B.R., M.J.S., G.C.C.), Harvard School of Public Health, Boston, Mass; and Merck Research Laboratories (C.C.C.), West Point, Pa.
Correspondence to Daniel H. Solomon, MD, MPH, Divisions of Pharmacoepidemiology and Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, 221 Longwood Ave, Suite 341, Boston MA 02115. E-mail dhsolomon{at}partners.org
Background— Rheumatoid arthritis may be associated with an increased risk of cardiovascular disease. We compared the incidence rates of myocardial infarction and stroke in subjects with and without rheumatoid arthritis.
Methods and Results— A prospective cohort study was conducted among the 114 342 women participating in the Nurses’ Health Study who were free of cardiovascular disease and rheumatoid arthritis at baseline in 1976. All self-reported cases of rheumatoid arthritis were confirmed by medical record review. Fatal and nonfatal myocardial infarctions and strokes were similarly confirmed. Multivariate pooled logistic regression was used to adjust for potential cardiovascular risk factors. Five hundred twenty-seven incident cases of rheumatoid arthritis and 3622 myocardial infarctions and strokes were confirmed during 2.4 million person-years of follow-up. The adjusted relative risk of myocardial infarction in women with rheumatoid arthritis compared with those without was 2.0 (95% confidence interval [CI], 1.23 to 3.29). For stroke, the adjusted relative risk was 1.48 (95% CI, 0.70 to 3.12). Women who had rheumatoid arthritis for at least 10 years had a risk for myocardial infarction of 3.10 (95% CI, 1.64 to 5.87).
Conclusion— In this large prospective cohort of women, participants with rheumatoid arthritis had a significantly increased risk of myocardial infarction but not stroke compared with those without rheumatoid arthritis. If these data are confirmed, aggressive coronary heart disease prevention strategies should be tested for persons with rheumatoid arthritis.
Key Words: cardiovascular diseases • myocardial infarction • stroke • epidemiology
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