Biomarker-related risk for myocardial infarction and serious infections in patients with rheumatoid arthritis: a population-based study.

Academic Article

Abstract

  • BACKGROUND: Rheumatoid arthritis (RA) disease activity and associated systemic inflammation has been associated with serious infection (SIEs), myocardial infarction (MI) and coronary heart disease (CHD) events based on a few registry studies or clinical trials. There are few data from large-scale population-based studies given feasibility challenges in conducting such investigations. METHODS: Multibiomarker disease activity (MBDA) test scores (n=77 641) were linked to Medicare for US patients with RA. Outcomes of interest were hospitalised pneumonia/sepsis (SIE), MI and a composite CHD outcome. The MBDA score ranges from 1 to 100 and was analysed as time-varying. Cox proportional hazards models evaluated the association between MBDA score and SIEs, MI and CHD events, controlling for potential confounders. A sensitivity analysis excluded C reactive protein (CRP) from the MBDA score. RESULTS: There were 17 433 and 16 796 patients eligible for the SIE and MI/CHD analyses, respectively. Mean (SD) age was 69 (11) years, 79% were women, 81% were white and 38% were disabled. Over 16 424 person-years of follow-up, there were 452 SIE events, 132 MIs and 181 CHD events. Higher MBDA scores were associated with SIEs (HR=1.32, 95% CI 1.23 to 1.41 per 10 unit MBDA score change). For MI/CHD events, a threshold effect was present; higher disease activity by MBDA score was associated with increased MI (HR=1.52, 95% CI 0.92 to 2.49) and CHD rates (HR=1.54, 95% CI 1.01 to 2.34, comparing scores ≥30 vs <30). Analyses of the MBDA score without CRP yielded similar results. CONCLUSION: Higher MBDA scores were associated with hospitalised infection, MI and CHD events in a large, predominantly older, US RA population.
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    Keywords

  • cardiovascular disease, infections, rheumatoid arthritis, Aged, Aged, 80 and over, Arthritis, Rheumatoid, Biomarkers, Cohort Studies, Coronary Disease, Disease Progression, Female, Hospitalization, Humans, Longitudinal Studies, Male, Middle Aged, Myocardial Infarction, Risk Assessment, Sepsis, Severity of Illness Index, United States
  • Digital Object Identifier (doi)

    Author List

  • Curtis JR; Xie F; Chen L; Saag KG; Yun H; Muntner P
  • Start Page

  • 386
  • End Page

  • 392
  • Volume

  • 77
  • Issue

  • 3