No increased cardiovascular mortality among early rheumatoid arthritis patients: a nationwide register study in 2000-2008.
OBJECTIVE
To assess cardiovascular (CV) mortality in early rheumatoid arthritis (RA), and the impact of RA medications on CV mortality.


METHODS
We identified all incident RA patients over 18 years of age diagnosed between 2000 and 2007 in Finland. Causes of death were analysed until the end of the year 2008. We used competing-risks regression models to assess the impact of different variables such as RA medications on CV mortality. CV mortality was compared with that of the age- and sex-specific general population.


RESULTS
We identified 14,878 incident RA patients (68% women, 63% rheumatoid factor (RF) positive, mean age 55.8/57.5 years in men/women), of whom more than 80% received RA medications for longer than 90% of their individual patient-years. By the end of 2008, 1,157 patients died, 501 (43%) of whom of CV causes. The standardised mortality ratio (SMR) for CV deaths in the entire RA cohort was 0.57 (95% CI 0.52 to 0.62). Along with traditional CV risk factors, the presence of RF and the use of glucocorticoids was associated with a higher risk of CV death, whereas the use of methotrexate was associated with a lower risk.


CONCLUSIONS
These nationwide results suggest that patients with recent-onset RA who receive consistent RA medication have no increased risk for CV mortality compared to the general population, at least in the early years of the disease. The use of methotrexate is associated with lower CV mortality, whereas the use of glucocorticoids is associated with a higher than average CV mortality.
Medical School, University of Helsinki, Helsinki, Finland.
Anne M
AM
Kerola
Department of Internal Medicine, University of Helsinki and Helsinki University Central Hospital; and Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland.
Tuomo V M
TV
Nieminen
Research Department, the Social Insurance Institution, Turku, Finland.
Lauri J
LJ
Virta
Unit of Primary Health Care, Helsinki University Central Hospital; and Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland.
Hannu
H
Kautiainen
Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.
Tuomas
T
Kerola
ORTON Rehabilitation Centre, ORTON Foundation, Helsinki, Finland.
Timo
T
Pohjolainen
Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti; and School of Medicine, Tampere University, Tampere, Finland.
Markku J
MJ
Kauppi
Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland.
Kari
K
Puolakka
D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality*; D002415:Cats; D002423:Cause of Death; D005260:Female; D005387:Finland / Q000453:epidemiology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012217:Rheumatoid Factor / Q000097:blood; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D013997:Time Factors
D018501:Antirheumatic Agents; D015415:Biomarkers; D005938:Glucocorticoids; D012217:Rheumatoid Factor; D008727:Methotrexate