title: Fragility Fractures Are Associated with an Increased Risk for Cardiovascular Events in Women and Men with Rheumatoid Arthritis: A Population-based Study.
abstract: Women and men with rheumatoid arthritis (RA) have an increased risk for fragility fractures and cardiovascular disease (CVD), each of which has been reported to contribute to excess morbidity and mortality in these patients. Fragility fractures share similar risk factors for CVD but may occur at relatively younger ages in patients with RA. We aimed to determine whether a fragility fracture predicts the development of CVD in women and men with RA.
  
  
  
  We studied a population-based cohort with incident RA from 1955 to 2007 and compared it with age- and sex-matched non-RA subjects. We identified fragility fractures and CVD events following the RA incidence/index date, along with relevant risk factors. We used Cox models to examine the association between fractures and the development of CVD, in which fractures and CVD risk factors were modeled as time-dependent covariates.
  
  
  
  There were 1171 subjects (822 women; 349 men) in each of the RA and non-RA cohorts. Over followup, there were 406 and 346 fragility fractures and 286 and 225 CVD events, respectively. The overall CVD risk was increased significantly for RA subjects following a fragility fracture (HR 1.81, 95% CI 1.38-2.37) but not for non-RA subjects (HR 1.18, 95% CI 0.85-1.63). Results were similar for women and men with RA.
  
  
  
  Fragility fractures in both women and men with RA are associated with an increased risk for CVD events and should raise an alert to clinicians to target these individuals for further screening and preventive strategies for CVD.
authors.affiliation: From the St. Vincent's Hospital, Dublin, Ireland; Division of Biomedical Statistics and Informatics, and Division of Epidemiology, Department of Health Sciences Research, and Division of Rheumatology, and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.|O. Ni Mhuircheartaigh, MB, BCh, BAO, BSc, MRCPI, St. Vincent's Hospital; C.S. Crowson, MS, Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, and Division of Rheumatology, Department of Medicine, Mayo Clinic; S.E. Gabriel, MD, MSc, Rutgers Robert Wood Johnson Medical School; V.L. Roger, MD, MPH, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic; L.J. Melton III, MD, MPH, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic; S. Amin, MD, CM, MPH, Division of Rheumatology, Department of Medicine, Mayo Clinic, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic.
authors.forename: Orla
authors.initials: O
authors.lastname: Ni Mhuircheartaigh
authors.affiliation: From the St. Vincent's Hospital, Dublin, Ireland; Division of Biomedical Statistics and Informatics, and Division of Epidemiology, Department of Health Sciences Research, and Division of Rheumatology, and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.|O. Ni Mhuircheartaigh, MB, BCh, BAO, BSc, MRCPI, St. Vincent's Hospital; C.S. Crowson, MS, Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, and Division of Rheumatology, Department of Medicine, Mayo Clinic; S.E. Gabriel, MD, MSc, Rutgers Robert Wood Johnson Medical School; V.L. Roger, MD, MPH, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic; L.J. Melton III, MD, MPH, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic; S. Amin, MD, CM, MPH, Division of Rheumatology, Department of Medicine, Mayo Clinic, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Crowson
authors.affiliation: From the St. Vincent's Hospital, Dublin, Ireland; Division of Biomedical Statistics and Informatics, and Division of Epidemiology, Department of Health Sciences Research, and Division of Rheumatology, and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.|O. Ni Mhuircheartaigh, MB, BCh, BAO, BSc, MRCPI, St. Vincent's Hospital; C.S. Crowson, MS, Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, and Division of Rheumatology, Department of Medicine, Mayo Clinic; S.E. Gabriel, MD, MSc, Rutgers Robert Wood Johnson Medical School; V.L. Roger, MD, MPH, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic; L.J. Melton III, MD, MPH, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic; S. Amin, MD, CM, MPH, Division of Rheumatology, Department of Medicine, Mayo Clinic, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic.
authors.forename: Sherine E
authors.initials: SE
authors.lastname: Gabriel
authors.affiliation: From the St. Vincent's Hospital, Dublin, Ireland; Division of Biomedical Statistics and Informatics, and Division of Epidemiology, Department of Health Sciences Research, and Division of Rheumatology, and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.|O. Ni Mhuircheartaigh, MB, BCh, BAO, BSc, MRCPI, St. Vincent's Hospital; C.S. Crowson, MS, Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, and Division of Rheumatology, Department of Medicine, Mayo Clinic; S.E. Gabriel, MD, MSc, Rutgers Robert Wood Johnson Medical School; V.L. Roger, MD, MPH, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic; L.J. Melton III, MD, MPH, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic; S. Amin, MD, CM, MPH, Division of Rheumatology, Department of Medicine, Mayo Clinic, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic.
authors.forename: Veronique L
authors.initials: VL
authors.lastname: Roger
authors.affiliation: From the St. Vincent's Hospital, Dublin, Ireland; Division of Biomedical Statistics and Informatics, and Division of Epidemiology, Department of Health Sciences Research, and Division of Rheumatology, and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.|O. Ni Mhuircheartaigh, MB, BCh, BAO, BSc, MRCPI, St. Vincent's Hospital; C.S. Crowson, MS, Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, and Division of Rheumatology, Department of Medicine, Mayo Clinic; S.E. Gabriel, MD, MSc, Rutgers Robert Wood Johnson Medical School; V.L. Roger, MD, MPH, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic; L.J. Melton III, MD, MPH, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic; S. Amin, MD, CM, MPH, Division of Rheumatology, Department of Medicine, Mayo Clinic, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic.
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Melton
authors.affiliation: From the St. Vincent's Hospital, Dublin, Ireland; Division of Biomedical Statistics and Informatics, and Division of Epidemiology, Department of Health Sciences Research, and Division of Rheumatology, and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA. amin.shreyasee@mayo.edu.|O. Ni Mhuircheartaigh, MB, BCh, BAO, BSc, MRCPI, St. Vincent's Hospital; C.S. Crowson, MS, Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, and Division of Rheumatology, Department of Medicine, Mayo Clinic; S.E. Gabriel, MD, MSc, Rutgers Robert Wood Johnson Medical School; V.L. Roger, MD, MPH, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic; L.J. Melton III, MD, MPH, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic; S. Amin, MD, CM, MPH, Division of Rheumatology, Department of Medicine, Mayo Clinic, and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic. amin.shreyasee@mayo.edu.
authors.forename: Shreyasee
authors.initials: S
authors.lastname: Amin
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
keywords: CARDIOVASCULAR DISEASE; FRACTURE; HEART FAILURE; ISCHEMIC HEART DISEASE; RHEUMATOID ARTHRITIS