title: Declines in mortality from acute myocardial infarction in successive incidence and birth cohorts of patients with rheumatoid arthritis.
abstract: BACKGROUND
  Patients with rheumatoid arthritis are at high risk for acute myocardial infarction (AMI). The treatment of rheumatoid arthritis has become more intensive over the past 2 decades, resulting in tighter control of inflammation and lower levels of disability. The impact of this on atherosclerotic cardiovascular diseases is not known.
  
  
  RESULTS
  Death rates from AMI in a cohort of 3862 patients with rheumatoid arthritis followed up from 1980 to 1997 were studied. Time trends in AMI mortality among successive incidence and birth cohorts were examined by use of multivariable Poisson regression models and by comparing standardized mortality ratios. The mean age was 56 years in this predominantly female cohort (76%), and median disease duration was 6.5 years. During the period of observation, the use of methotrexate increased substantially, whereas that of prednisone was relatively stable. Over the 22,209 person-years of observation, there were 157 deaths as a result of AMI, with a death rate of 7.06 per 1000 person-years. Mortality rates were higher in older age groups and in men. After adjustment for age, sex, race, and disease duration, the risk of AMI declined in successive incidence years (relative risk, 0.94; 95% CI, 0.92 to 0.96). Patients with rheumatoid arthritis incident after 1990 did not have excess AMI mortality compared with general population. Declines in mortality trends were observed in successive birth cohorts as well.
  
  
  CONCLUSIONS
  Mortality as a result of AMI among patients with rheumatoid arthritis has declined over time.
authors.affiliation: Stanford University, Division of Immunology, Department of Medicine, 1000 Welch Rd, Suite 203, Palo Alto, Calif, USA. eswar_krishnan@hotmail.com
authors.forename: Eswar
authors.initials: E
authors.lastname: Krishnan
authors.forename: Vijaya Bharathi
authors.initials: VB
authors.lastname: Lingala
authors.forename: Gurkirpal
authors.initials: G
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D019090:Case Management / Q000639:trends; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality*; D009656:North America / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D012044:Regression Analysis; D012306:Risk
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D011241:Prednisone; D008727:Methotrexate