title: Trend in and predictors for cardiovascular mortality in patients with rheumatoid arthritis over a period of 15 years: a prospective cohort study.
abstract: OBJECTIVE
  To investigate a) the cardiovascular (CV) mortality in a clinical cohort of patients with established rheumatoid arthritis (RA) in comparison with the general population over 15 years, b) the trend in this CV mortality during the study period, and c) for a broad range of predictors, which baseline variables predict CV mortality.
  
  
  METHODS
  In 1997, a sample of 1222 patients was randomly selected from the register of a rheumatology outpatient clinic in Amsterdam. Their CV mortality between 1997 and 2012 was obtained from Statistics Netherlands. The standardised mortality ratio (SMR) for CV mortality was calculated. A linear poisson regression analysis was performed to investigate if there was a trend in SMR over time. A Cox regression analysis was performed to determine which baseline variables predicted CV mortality.
  
  
  RESULTS
  Mean age of the population at baseline was 60.4 (SD 15.4) years and 72.6% of the patients were women. Estimated SMR (95% confidence interval) for CV mortality was 1.24 (1.05, 1.43). The SMR decreased with 3% annually (p=0.16). Higher age, higher erythrocyte sedimentation rate, having CV comorbidity and diabetes mellitus (DM) were predictors for CV mortality.
  
  
  CONCLUSIONS
  CV mortality among patients with RA in the past 15 years was still higher than in the general population. CV mortality decrease was not statistically significant. As CV mortality in RA is still higher than in the general population, continued attention for CV diseases in RA is important. Both tight control of disease activity and good care for comorbid conditions (CV diseases and DM) are advocated.
authors: Amsterdam Rehabilitation Research Center/Reade; and Department of Social Medicine, Academic Medical Center, University of Amsterdam, The Netherlands. j.vd.hoek@reade.nl.
authors: Joëlle
authors: J
authors: van den Hoek
authors: Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands.
authors: Leo D
authors: LD
authors: Roorda
authors: National Institute of Public Health and the Environment, Bilthoven; and Biometrics, Wageningen University and Research Centre, Wageningen, The Netherlands.
authors: Hendriek C
authors: HC
authors: Boshuizen
authors: Jan van Breemen Research Institute/Reade, Amsterdam, The Netherlands.
authors: Gerard J
authors: GJ
authors: Tijhuis
authors: Amsterdam Rehabilitation Research Center/Reade; and Departments of Rehabilitation and Psychiatry, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands.
authors: Joost
authors: J
authors: Dekker
authors: Department of Social Medicine, Academic Medical Center, University of Amsterdam, The Netherlands.
authors: Geertrudis A
authors: GA
authors: van den Bos
authors: Jan van Breemen Research Institute/Reade, Amsterdam, The Netherlands.
authors: Michael T
authors: MT
authors: Nurmohamed
mesh_terms: D000367:Age Factors; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000401:mortality*; D001799:Blood Sedimentation; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality*; D016022:Case-Control Studies; D002423:Cause of Death / Q000639:trends; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors