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Is Rheumatoid Arthritis a Cardiovascular Risk Equivalent to Diabetes?

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Curtis JR1,2, Yang S1, Singh JA1, Xie F1, Chen L1, Yun H1, Muntner P1, Kent ST1, Levitan EB1, Safford MM1, Saag KG1, Zhang J1,2. Arthritis Care Res (Hoboken). 2018 Feb 6. doi: 10.1002/acr.23535. [Epub ahead of print]

Abstract

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1 Department of Epidemiology, University of Alabama at Birmingham.

2 Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham.

Abstract

BACKGROUND/PURPOSE: The 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol treatment guidelines recommend statins for patients with diabetes aged 40-75 years due to their elevated cardiovascular disease (CVD) risk. We compared the incidence of hospitalized acute myocardial infarction (MI), stroke, and coronary revascularization according to whether patients had diabetes, rheumatoid arthritis (RA), both or neither.

METHODS: Using 2006 to 2010 private and public health plan claims, we identified 4 mutually exclusive retrospective cohorts age>40: patients with 1) RA and diabetes; 2) RA only; 3) diabetes only; 4) neither condition. Patients with prevalent CVD were excluded. Outcomes included acute MI and stroke identified from inpatient discharge diagnosis codes, and coronary revascularization from procedure codes. Across the four cohorts, we calculated incidence rates (IRs) of the outcomes, standardized to the 2010 U.S. census age and sex distribution.

RESULTS: We identified 920,772 eligible participants. The age-sex standardized IRs (per 1,000 person-years) for MI were highest among patients with RA and diabetes (IR=12.6, 95%CI 10.7-14.7), followed by patients with diabetes only (IR=10.7, 95%CI 10.3-11.0), RA only (IR=5.7,95%CI 5.2-6.3), and with neither condition (IR=4.2, 95%CI 4.1-4.3).

CONCLUSION: Findings from the present study suggest that while CVD risk in RA is elevated, it is lower in magnitude compared to the CVD risk associated with diabetes. It therefore may not be appropriate to consider RA a diabetes risk-equivalent with respect to hyperlipidemia management.