Rheumatoid Arthritis Disadvantages Younger Patients for Cardiovascular Diseases: A Meta-Analysis.
BACKGROUND
The incidence of cardiovascular diseases (CVD) is increased in rheumatoid arthritis (RA) patients. It remains unclear whether the load of RA increases cardiovascular (CV) risk especially in female and in younger RA patients. In the present study we aim to analyse the influence of age and gender on CV risk in RA relative to the general population, using meta-analysis of direct comparative studies.


METHODS
Systematic literature search was performed in MEDLINE for studies reporting on occurrence of CV events in RA as compared to the general population, stratified for gender and/or age. Quality was appraised using the Newcastle-Ottawa scale. Meta-analysis was performed on rate ratios using inverse variance methods.


RESULTS
There were 1372 records screened and 13 studies included. RA females and males have a similar higher risk (95%CI) to develop stroke with RR 1.35 (1.30-1.40) and RR 1.31 (1.21-1.43); coronary artery disease with RR 1.65 (1.54-1.76) versus RR 1.55 ((1.41-1.69) in men; cardiovascular disease with RR 1.56 (1.49-1.62) versus 1.50 (1.41-1.60). The highest incidence of CV events was observed in the youngest patients, RR 2.59 (1.77-3.79), whereas older patients had the lowest relative risk when compared to the general population, RR 1.27 (1.16-1.38).


CONCLUSIONS
The relative risk of RA patients for CVD is age dependent, but does not depend on gender: the relative risk on CVD appears to be equally raised for males and females, while relatively young RA patients (<50 years) have the highest, and older patients the lowest relative risk.
Department of Rheumatology Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Jaap
J
Fransen
Department of Oncology, Faculty of Medicine, University of Alberta, Edmonton, Canada.
Seyyed M R
SM
Kazemi-Bajestani
Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Sebastian J H
SJ
Bredie
Department of Rheumatology Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.|Department of Rheumatology, Bernhoven Hospital, Uden, The Netherlands.
Calin D
CD
Popa
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology