Abstract 1639: Trends in Cardiovascular Mortality in Patients With Rheumatoid Arthritis Over 50 years: A Systematic Review and Meta-analysis of Cohort Studies
OBJECTIVES: Rheumatoid arthritis (RA) is known to be associated with a high cardiovascular (CV) risk. Recent improvements in diagnosis and management of RA have led to a less severe disability. Whether this improvement can be transferred to cardiovascular course is unknown. We set out to determine if CV mortality associated with RA has decreased over the last 50 years.
METHODS: We performed a systematic review and a meta-analysis of literature in MEDLINE and EMBASE databases from Jan 1960 to Nov 2008. All cohort studies reporting CV mortality risk were included. We then calculated pooled standardized mortality ratios (SMR) of CV mortality, and determined their change over time using meta-regression analysis.
RESULTS: 17 studies were analyzed, corresponding to a total of 91,916 patients. The overall pooled SMR was 1.6 (95% CI 1.5–1.8; I2=93%; p(het)<0.0001). Mid-cohort year ranged from 1945 to 1995 (<1980, 7 studies; 1980 to 1990, 5 studies; >1990, 5 studies). Meta-regression analyses did not reveal any trend in SMR over time (p=0.784) (figure 1⇓), nor any relation with disease duration at the time of inclusion (p=0.513).
CONCLUSIONS: Our results show that RA is associated with a 60% increase in risk of CV death compared to general population. In addition, SMR for CV death has not changed over the last decades. Targeting a reduction in CV mortality should thus still be considered as pivotal in RA patients.