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(Circulation. 2004;110:1774-1779.)
© 2004 American Heart Association, Inc.

Coronary Heart Disease

Declines in Mortality From Acute Myocardial Infarction in Successive Incidence and Birth Cohorts of Patients With Rheumatoid Arthritis

From Stanford University, Division of Immunology (E.K., V.B.L.), and the Divisions of Gastroenterology and Hepatology (G.S.), Department of Medicine, 1000 Welch Rd, Suite 203, Palo Alto, Calif.

Correspondence to Eswar Krishnan, MD, MPhil, Stanford University, Division of Immunology, Department of Medicine, 1000 Welch Rd, Suite 203, Palo Alto, Calif. E-mail eswar_krishnan{at}hotmail.com

Received February 7, 2004; revision received May 20, 2004; accepted May 24, 2004.

Background— Patients with rheumatoid arthritis are at high risk for acute myocardial infarction (AMI). The treatment of rheumatoid arthritis has become more intensive over the past 2 decades, resulting in tighter control of inflammation and lower levels of disability. The impact of this on atherosclerotic cardiovascular diseases is not known.

Methods and Results— Death rates from AMI in a cohort of 3862 patients with rheumatoid arthritis followed up from 1980 to 1997 were studied. Time trends in AMI mortality among successive incidence and birth cohorts were examined by use of multivariable Poisson regression models and by comparing standardized mortality ratios. The mean age was 56 years in this predominantly female cohort (76%), and median disease duration was 6.5 years. During the period of observation, the use of methotrexate increased substantially, whereas that of prednisone was relatively stable. Over the 22 209 person-years of observation, there were 157 deaths as a result of AMI, with a death rate of 7.06 per 1000 person-years. Mortality rates were higher in older age groups and in men. After adjustment for age, sex, race, and disease duration, the risk of AMI declined in successive incidence years (relative risk, 0.94; 95% CI, 0.92 to 0.96). Patients with rheumatoid arthritis incident after 1990 did not have excess AMI mortality compared with general population. Declines in mortality trends were observed in successive birth cohorts as well.

Conclusions— Mortality as a result of AMI among patients with rheumatoid arthritis has declined over time.

Key Words: myocardial infarction • rheumatoid arthritis • mortality • risk • trend

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