Extent of inflammation predicts cardiovascular disease and overall mortality in seropositive rheumatoid arthritis. A retrospective cohort study from disease onset.
OBJECTIVE
To identify predictors for cardiovascular disease (CVD) and for overall survival in patients with rheumatoid arthritis (RA) followed from disease onset.


METHODS
A retrospective cohort of patients with seropositive RA and disease onset between 1974 and 1978 (n = 211) was followed up at the end of 1995. Potential predictors for CVD, as measured by "the first cardiovascular event," and for overall survival were registered. The predictors were identified by extended Cox regression models.


RESULTS
In simple Cox regression analysis, male sex, higher age at disease onset, HLA-B27, high disease activity, corticosteroid treatment early in disease, and hypertension significantly increased risk of cardiovascular event. Higher educational level, extensive disease modifying antirheumatic drug (DMARD) treatment, and corticosteroids > or =1 yr before event decreased the risk. In multiple Cox regression analysis, male sex, high age at disease onset, hypertension, higher haptoglobin level at disease onset, and corticosteroid treatment early in disease increased risk of CVD. In a multiple model comprising only patients with CVD, corticosteroids delayed the event. A high last registered erythrocyte sedimentation rate (ESR) value before event increased CVD risk, in particular when early in disease progression. Decreased life span was predicted by higher age at disease onset, male sex, low education level, high disease activity, hypertension, and CVD. HLA-B27 was associated with decreased life span, as was early, but not extensive corticosteroid treatment. DMARD treatment was associated with decreased mortality risk, as was the presence of joint prosthesis. In multiple regression, male sex, higher age at disease onset, atlantoaxial subluxation early in disease, hypertension, and cardiovascular event increased mortality. A high last registered ESR value before event or death added to that risk.


CONCLUSIONS
The study emphasizes the importance of inflammation as an important risk indicator for CVD and mortality in RA. The positive impact of disease activity reducing treatment on CVD risk and survival is suggested.
Wållberg-Jonsson
S
S
Department of Rheumatology, University Hospital, Institution of Statistics, University of Umeå, Sweden.
Johansson
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H
Ohman
M L
ML
Rantapää-Dahlqvist
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S
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D017677:Age Distribution; D017668:Age of Onset; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000276:immunology / Q000401:mortality*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D015796:HLA-B27 Antigen / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000276:immunology / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011655:Pulmonary Embolism / Q000276:immunology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000276:immunology / Q000401:mortality; D016019:Survival Analysis; D020246:Venous Thrombosis / Q000276:immunology / Q000401:mortality
D000305:Adrenal Cortex Hormones; D015796:HLA-B27 Antigen