Browse > Article
http://dx.doi.org/10.24304/kjcp.2019.29.2.109

The Risk of Cardiovascular Disease and Diabetes in Rheumatoid Arthritis Patients: A Propensity Score Analysis  

Rhew, Kiyon (College of Pharmacy, Dongduk Women's University)
Publication Information
Korean Journal of Clinical Pharmacy / v.29, no.2, 2019 , pp. 109-114 More about this Journal
Abstract
Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease that manifests as joint damage or athletic disability via sustained inflammation of the synovial membrane. The risk of cardiovascular disease (CVD) is higher in RA patients. This study aimed at evaluating the association between CVD comorbidities and RA by comparing a pharmacotherapy group with a non-pharmacotherapy group. Methods: Patient sample data from the Health Insurance Review and Assessment Service (HIRA-NPS-2016) were used. Inverse probability of treatment weighting (IPTW) using the propensity score was used to minimize the differences in patient characteristics. Logistic regression analysis was used to evaluate the risk of CVD comorbidities. Results: The analyses included 1,207,213 patients, of which 33,122 (2.8%) had RA. The odds ratios (OR) of CVD comorbidities were increased in RA patients; ischemic heart disease (IHD: OR 1.75; 95% CI 1.73, 1.77), cerebral infarction (CERI: OR 1.28; 95% CI 1.26, 1.30), hypertension (HTN: OR 1.44; 95% CI 1.43, 1.45), diabetes mellitus (DM: OR 2.04; 95% CI 2.03, 2.06), and dyslipidemia (DL: OR 3.49; 95% CI 3.47, 3.51). The ORs of IHD, CERI, HTN, and DM in the traditional DMARD and biologic treatment groups were decreased, compared with those in the non-pharmacotherapy group. Conclusions: Thus, CVD risk was higher in RA patients, considering age, sex, and socioeconomic status. Appropriate pharmacotherapy could decrease the risk of CVD comorbidities in RA patients.
Keywords
Rheumatoid arthritis; cardiovascular disease; DMARD; biologic agents;
Citations & Related Records
연도 인용수 순위
  • Reference
1 England BR, Thiele GM, Anderson DR, et al. Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications. BMJ 2018 Apr 23;361:k1036. doi: 10.1136/bmj.k1036   DOI
2 Arts EE, Fransen J, Den Broeder AA, et al. Low disease activity (DAS28$\leq$3.2) reduces the risk of first cardiovascular event in rheumatoid arthritis: a time-dependent Cox regression analysis in a large cohort study. Ann Rheum Dis 2017;76:1693-9. doi: 10.1136/annrheumdis-2016-210997.   DOI
3 Solomon DH, Reed GW, Kremer JM, et al. Disease activity in rheumatoid arthritis and the risk of cardiovascular events. Arthritis Rheumatol 2015;67:1449-55.   DOI
4 Ljung L, Rantapaa-Dahlqvist S, Jacobsson LT, et al. Response to biological treatment and subsequent risk of coronary events in rheumatoid arthritis. Ann Rheum Dis 2016;75:2087-94.   DOI
5 Rempenault C, Combe B, Barnetche T, et al. Metabolic and cardiovascular benefits of hydroxychloroquine in patients with rheumatoid arthritis: a systematic review and meta-analysis. Ann Rheum Dis 2018;77(1):98-103.   DOI
6 Saag KG, Teng GG, Patkar NM, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum 2008;59:762-84.   DOI
7 Singh JA, Saag KG, Bridges SL, et al. 2015 American College of Rheumatology Guideline for the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken) 2016;68(1):1-25.   DOI
8 Singh JA, Furst DE, Bharat A, et al. 2012 Update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res 2012;64:625-39.   DOI
9 O'Neill F, Charakida M, Topham E, et al. Anti-inflammatory treatment improves high-density lipoprotein function in rheumatoid arthritis. Heart 2017;103:766-73.   DOI
10 Micha R, Imamura F, Wyler von Ballmoos M, et al. Systematic review and meta-analysis of methotrexate use and risk of cardiovascular disease. Am J Cardiol 2011;108(9):1362-70.   DOI
11 Agca R, Heslinga SC, Rollefstad S, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 2017;76:17-28.   DOI
12 Boo S, Oh H, Froelicher ES, et al. Knowledge and perception of cardiovascular disease risk among patients with rheumatoid arthritis. PLoS One 2017;12:e0176291   DOI
13 Kim L, Kim JA, Kim S. A guide for the utilization of Health Insurance Review and Assessment Service National Patient Samples. Epidemiol Health 2014;36:e2014008.
14 Robertson J, Peters MJ, McInnes IB, et al. Changes in lipid levels with inflammation and therapy in RA: a maturing paradigm. Nat Rev Rheumatol 2013;9:513-23.   DOI
15 Merkle CJ, Moore IM, Penton BS, et al. Methotrexate causes apoptosis in postmitotic endothelial cells. Biol Res Nurs 2000;2:5-14.   DOI
16 van Sijl AM, Peters MJ, Knol DL, et al. The effect of TNF-alpha blocking therapy on lipid levels in rheumatoid arthritis: a metaanalysis. Semin Arthritis Rheum 2011;41:393-400.   DOI
17 Choi HK, Hernan MA, Seeger JD, et al. Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet 2002;359:1173-7.   DOI
18 Greenberg JD, Kremer JM, Curtis JR, et al. Tumour necrosis factor antagonist use and associated risk reduction of cardiovascular events among patients with rheumatoid arthritis. Ann Rheum Dis 2011;70:576-82.   DOI
19 Barnabe C, Martin BJ, Ghali WA. Systematic review and metaanalysis: anti-tumor necrosis factor ${\alpha}$ therapy and cardiovascular events in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2011;63:522-9.   DOI
20 Dierkes J and Westphal S. Effect of drugs on homocysteine concentrations. Semin Vasc Med 2005;5:124-39.   DOI
21 Lim DT, Cannella AC, Michaud KD, et al. Cardiovascular risk and the use of biologic agents in rheumatoid arthritis. Curr Rheumatol Rep 2014;16:459.   DOI
22 Avina-Zubieta JA, Choi HK, Sadatsafavi M, et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum 2008;59:1690-7.   DOI
23 Nicola PJ, Crowson CS, Maradit-Kremers H, et al. Contribution of congestive heart failure and ischemic heart disease to excess mortality in rheumatoid arthritis. Arthritis Rheum 2006;54:60-7.   DOI
24 Hunter TM, Boytsov NN, Zhang X, et al. Prevalence of rheumatoid arthritis in the United States adult population in healthcare claims databases, 2004-2014. Rheumatol Int 2017;37(9):1551-7.   DOI
25 Schmidt TJ, Avina-Zubieta JA, Sayre EC, et al. Cardiovascular Disease Prevention in Rheumatoid Arthritis: Compliance with Diabetes Screening Guidelines. J Rheumatol 2018;45:1367-74.   DOI
26 Austin PC and Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 2015;34(28):3661-79.   DOI
27 Glynn RJ, Schneeweiss S, Sturmer T. Indications for propensity scores and review of their use in pharmacoepidemiology. Basic Clin Pharmacol Toxicol 2006;98(3):253-9.   DOI
28 Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet 2010;376:1094-108.   DOI
29 Silman AJ and Pearson JE. Epidemiology and genetics of rheumatoid arthritis. Arthritis Res 2002;4(suppl):S265-72.   DOI
30 Minichiello E, Semerano L, Boissier MC. Time trends in the incidence, prevalence, and severity of rheumatoid arthritis: A systematic literature review. Joint Bone Spine 2016;83(6):625-30.   DOI
31 Naqvi AA, Hassali MA, Aftab MT. Epidemiology of rheumatoid arthritis, clinical aspects and socio-economic determinants in Pakistani patients: A systematic review and meta-analysis. J Pak Med Assoc 2019;69:389-98.
32 Sandoo A, Chanchlani N, Hodson J, et al. Classical cardiovascular disease risk factors associate with vascular function and morphology in rheumatoid arthritis: a six-year prospective study. Arthritis Res Ther 2013;15:R203. doi:10.1186/ar4396 pmid:24289091   DOI
33 Liao KP. Cardiovascular disease in patients with rheumatoid arthritis. Trends Cardiovasc Med 2017;27:136-40.   DOI