title: Disease duration and severity impacts on long-term cardiovascular events in Japanese patients with rheumatoid arthritis.
abstract: BACKGROUND
  Rheumatoid arthritis (RA) increases the mortality and morbidity of cardiovascular disease (CVD). However, the relationship between RA and the risk of CVD in the Japanese population remains unclear.
  
  
  RESULTS
  This study comprised 571 RA patients who were admitted to Juntendo University Hospital from January 1990 to December 2000. Cardiovascular events (CVEs) were defined as cardiac death, acute coronary syndrome (ACS), symptomatic stroke, and congestive heart failure. During follow-up (mean 11.7 ± 5.8 years), 7.5% of the patients died from all causes and 11.0% experienced CVEs. The morbidity of stroke and ACS was 3.6 and 2.5 per 1000 person-years, respectively. The mean RA disease duration at enrolment was significantly longer in patients who experienced CVEs than in those who did not experience CVEs (15.0 ± 12.7 years vs. 10. 8 ± 9.7 years; p = 0.01). Physical disabilities due to RA were more severe in patients who experienced CVEs than in those who did not experience CVEs. Patients with a long RA disease duration showed significantly higher event rates (p = 0.033). Cox proportional hazards analysis identified a longer RA duration as an independent risk factor for CVD (hazard ratio 1.57, 95% CI 1.09-2.30, p = 0.02).
  
  
  CONCLUSIONS
  Japanese RA patients showed a relatively high incidence of CVD, despite the fact that they had few coronary risk factors. The RA disease duration was an independent risk factor for CVEs.
authors.affiliation: Department of Cardiovascular Medicine, Juntendo University, School of Medicine, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Masuda
authors.affiliation: Department of Cardiovascular Medicine, Juntendo University, School of Medicine, Tokyo, Japan. Electronic address: tetsuro@juntendo.ac.jp.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Department of Cardiovascular Medicine, Juntendo University, School of Medicine, Tokyo, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Shimada
authors.affiliation: Department of Internal Medicine and Rheumatology, Juntendo University, School of Medicine, Tokyo, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Tamura
authors.affiliation: Department of Internal Medicine and Rheumatology, Juntendo University, School of Medicine, Tokyo, Japan.
authors.forename: Ran
authors.initials: R
authors.lastname: Matsudaira
authors.affiliation: Department of Cardiovascular Medicine, Juntendo University, School of Medicine, Tokyo, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Yoshihara
authors.affiliation: Department of Cardiovascular Medicine, Juntendo University, School of Medicine, Tokyo, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Ohsaka
authors.affiliation: Department of Cardiovascular Medicine, Juntendo University, School of Medicine, Tokyo, Japan.
authors.forename: Eiryu
authors.initials: E
authors.lastname: Sai
authors.affiliation: Department of Cardiovascular Medicine, Juntendo University, School of Medicine, Tokyo, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Matsumori
authors.affiliation: Department of Cardiovascular Medicine, Juntendo University, School of Medicine, Tokyo, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Fukao
authors.affiliation: Department of Cardiovascular Medicine, Juntendo University, School of Medicine, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hiki
authors.affiliation: Department of Cardiovascular Medicine, Juntendo University, School of Medicine, Tokyo, Japan.
authors.forename: Atsumi
authors.initials: A
authors.lastname: Kume
authors.affiliation: Department of Cardiovascular Medicine, Juntendo University, School of Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kiyanagi
authors.affiliation: Department of Internal Medicine and Rheumatology, Juntendo University, School of Medicine, Tokyo, Japan.
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Takasaki
authors.affiliation: Department of Cardiovascular Medicine, Juntendo University, School of Medicine, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D044466:Asian People; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D006233:Persons with Disabilities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Cardiovascular disease; Inflammation; Risk factors