Abstract 3154: Cardiovascular Morbidity And Mortality In Rheumatoid Arthritis: A Systematic Review And Meta-analysis Of Cohort Studies
There is a growing body of evidence that overall cardiovascular mortality is increased in patients with rheumatoid arthritis (RA). However, the magnitude of this risk and the relative contribution of myocardial infarction (MI) and stroke remain unclear. We performed a systematic review and a meta-analysis of published data to estimate the magnitude of the relative increase in vascular risk associated with RA and to determine whether the relation differed between MI and stroke. We searched MEDLINE and EMBASE databases from Jan 1960 to Dec 2007. References from identified articles were also reviewed. Any cohort study which reported the risk of CV mortality, MI, or stroke in relation to RA, with available crude numbers, was eligible. Pooled estimates of standardized mortality ratio (SMR) and Relative Risk (RR) were obtained using a random effect (Stata sotware). SMR were considered for comparison with general population and RR for comparison between exposed and non exposed populations. 23 studies fulfilled our inclusion criteria. The results show a significant increase in CV mortality overall and fatal MI and stroke. Moreover, the investigations of the occurrence of non fatal CV events confirm the increased risk associated with RA. The detailed results are shown in tables. Significant heterogeneity was observed for overall CV risk and MI but not for stroke analyses. Our results confirm that RA patients have increased CV mortality. In addition, MI and stroke are increased in RA patients (RR 1.9 for MI and stroke) and account for the observed differences in CV mortality.