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Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study

INTRODUCTION: We analyzed the prevalence of cardiovascular (CV) disease in patients with rheumatoid arthritis (RA) and its association with traditional CV risk factors, clinical features of RA, and the use of disease-modifying antirheumatic drugs (DMARDs) in a multinational cross-sectional cohort of...

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Autores principales: Naranjo, Antonio, Sokka, Tuulikki, Descalzo, Miguel A, Calvo-Alén, Jaime, Hørslev-Petersen, Kim, Luukkainen, Reijo K, Combe, Bernard, Burmester, Gerd R, Devlin, Joe, Ferraccioli, Gianfranco, Morelli, Alessia, Hoekstra, Monique, Majdan, Maria, Sadkiewicz, Stefan, Belmonte, Miguel, Holmqvist, Ann-Carin, Choy, Ernest, Tunc, Recep, Dimic, Aleksander, Bergman, Martin, Toloza, Sergio, Pincus, Theodore
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453774/
https://www.ncbi.nlm.nih.gov/pubmed/18325087
http://dx.doi.org/10.1186/ar2383
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author Naranjo, Antonio
Sokka, Tuulikki
Descalzo, Miguel A
Calvo-Alén, Jaime
Hørslev-Petersen, Kim
Luukkainen, Reijo K
Combe, Bernard
Burmester, Gerd R
Devlin, Joe
Ferraccioli, Gianfranco
Morelli, Alessia
Hoekstra, Monique
Majdan, Maria
Sadkiewicz, Stefan
Belmonte, Miguel
Holmqvist, Ann-Carin
Choy, Ernest
Tunc, Recep
Dimic, Aleksander
Bergman, Martin
Toloza, Sergio
Pincus, Theodore
author_facet Naranjo, Antonio
Sokka, Tuulikki
Descalzo, Miguel A
Calvo-Alén, Jaime
Hørslev-Petersen, Kim
Luukkainen, Reijo K
Combe, Bernard
Burmester, Gerd R
Devlin, Joe
Ferraccioli, Gianfranco
Morelli, Alessia
Hoekstra, Monique
Majdan, Maria
Sadkiewicz, Stefan
Belmonte, Miguel
Holmqvist, Ann-Carin
Choy, Ernest
Tunc, Recep
Dimic, Aleksander
Bergman, Martin
Toloza, Sergio
Pincus, Theodore
author_sort Naranjo, Antonio
collection PubMed
description INTRODUCTION: We analyzed the prevalence of cardiovascular (CV) disease in patients with rheumatoid arthritis (RA) and its association with traditional CV risk factors, clinical features of RA, and the use of disease-modifying antirheumatic drugs (DMARDs) in a multinational cross-sectional cohort of nonselected consecutive outpatients with RA (The Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis Program, or QUEST-RA) who were receiving regular clinical care. METHODS: The study involved a clinical assessment by a rheumatologist and a self-report questionnaire by patients. The clinical assessment included a review of clinical features of RA and exposure to DMARDs over the course of RA. Comorbidities were recorded; CV morbidity included myocardial infarction, angina, coronary disease, coronary bypass surgery, and stroke. Traditional risk factors recorded were hypertension, hyperlipidemia, diabetes mellitus, smoking, physical inactivity, and body mass index. Unadjusted and adjusted hazard ratios (HRs) (95% confidence interval [CI]) for CV morbidity were calculated using Cox proportional hazard regression models. RESULTS: Between January 2005 and October 2006, the QUEST-RA project included 4,363 patients from 48 sites in 15 countries; 78% were female, more than 90% were Caucasian, and the mean age was 57 years. The prevalence for lifetime CV events in the entire sample was 3.2% for myocardial infarction, 1.9% for stroke, and 9.3% for any CV event. The prevalence for CV risk factors was 32% for hypertension, 14% for hyperlipidemia, 8% for diabetes, 43% for ever-smoking, 73% for physical inactivity, and 18% for obesity. Traditional risk factors except obesity and physical inactivity were significantly associated with CV morbidity. There was an association between any CV event and age and male gender and between extra-articular disease and myocardial infarction. Prolonged exposure to methotrexate (HR 0.85; 95% CI 0.81 to 0.89), leflunomide (HR 0.59; 95% CI 0.43 to 0.79), sulfasalazine (HR 0.92; 95% CI 0.87 to 0.98), glucocorticoids (HR 0.95; 95% CI 0.92 to 0.98), and biologic agents (HR 0.42; 95% CI 0.21 to 0.81; P < 0.05) was associated with a reduction of the risk of CV morbidity; analyses were adjusted for traditional risk factors and countries. CONCLUSION: In conclusion, prolonged use of treatments such as methotrexate, sulfasalazine, leflunomide, glucocorticoids, and tumor necrosis factor-alpha blockers appears to be associated with a reduced risk of CV disease. In addition to traditional risk factors, extra-articular disease was associated with the occurrence of myocardial infarction in patients with RA.
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spelling pubmed-24537742008-07-12 Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study Naranjo, Antonio Sokka, Tuulikki Descalzo, Miguel A Calvo-Alén, Jaime Hørslev-Petersen, Kim Luukkainen, Reijo K Combe, Bernard Burmester, Gerd R Devlin, Joe Ferraccioli, Gianfranco Morelli, Alessia Hoekstra, Monique Majdan, Maria Sadkiewicz, Stefan Belmonte, Miguel Holmqvist, Ann-Carin Choy, Ernest Tunc, Recep Dimic, Aleksander Bergman, Martin Toloza, Sergio Pincus, Theodore Arthritis Res Ther Research Article INTRODUCTION: We analyzed the prevalence of cardiovascular (CV) disease in patients with rheumatoid arthritis (RA) and its association with traditional CV risk factors, clinical features of RA, and the use of disease-modifying antirheumatic drugs (DMARDs) in a multinational cross-sectional cohort of nonselected consecutive outpatients with RA (The Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis Program, or QUEST-RA) who were receiving regular clinical care. METHODS: The study involved a clinical assessment by a rheumatologist and a self-report questionnaire by patients. The clinical assessment included a review of clinical features of RA and exposure to DMARDs over the course of RA. Comorbidities were recorded; CV morbidity included myocardial infarction, angina, coronary disease, coronary bypass surgery, and stroke. Traditional risk factors recorded were hypertension, hyperlipidemia, diabetes mellitus, smoking, physical inactivity, and body mass index. Unadjusted and adjusted hazard ratios (HRs) (95% confidence interval [CI]) for CV morbidity were calculated using Cox proportional hazard regression models. RESULTS: Between January 2005 and October 2006, the QUEST-RA project included 4,363 patients from 48 sites in 15 countries; 78% were female, more than 90% were Caucasian, and the mean age was 57 years. The prevalence for lifetime CV events in the entire sample was 3.2% for myocardial infarction, 1.9% for stroke, and 9.3% for any CV event. The prevalence for CV risk factors was 32% for hypertension, 14% for hyperlipidemia, 8% for diabetes, 43% for ever-smoking, 73% for physical inactivity, and 18% for obesity. Traditional risk factors except obesity and physical inactivity were significantly associated with CV morbidity. There was an association between any CV event and age and male gender and between extra-articular disease and myocardial infarction. Prolonged exposure to methotrexate (HR 0.85; 95% CI 0.81 to 0.89), leflunomide (HR 0.59; 95% CI 0.43 to 0.79), sulfasalazine (HR 0.92; 95% CI 0.87 to 0.98), glucocorticoids (HR 0.95; 95% CI 0.92 to 0.98), and biologic agents (HR 0.42; 95% CI 0.21 to 0.81; P < 0.05) was associated with a reduction of the risk of CV morbidity; analyses were adjusted for traditional risk factors and countries. CONCLUSION: In conclusion, prolonged use of treatments such as methotrexate, sulfasalazine, leflunomide, glucocorticoids, and tumor necrosis factor-alpha blockers appears to be associated with a reduced risk of CV disease. In addition to traditional risk factors, extra-articular disease was associated with the occurrence of myocardial infarction in patients with RA. BioMed Central 2008 2008-03-06 /pmc/articles/PMC2453774/ /pubmed/18325087 http://dx.doi.org/10.1186/ar2383 Text en Copyright © 2008 Naranjo et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Naranjo, Antonio
Sokka, Tuulikki
Descalzo, Miguel A
Calvo-Alén, Jaime
Hørslev-Petersen, Kim
Luukkainen, Reijo K
Combe, Bernard
Burmester, Gerd R
Devlin, Joe
Ferraccioli, Gianfranco
Morelli, Alessia
Hoekstra, Monique
Majdan, Maria
Sadkiewicz, Stefan
Belmonte, Miguel
Holmqvist, Ann-Carin
Choy, Ernest
Tunc, Recep
Dimic, Aleksander
Bergman, Martin
Toloza, Sergio
Pincus, Theodore
Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study
title Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study
title_full Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study
title_fullStr Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study
title_full_unstemmed Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study
title_short Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study
title_sort cardiovascular disease in patients with rheumatoid arthritis: results from the quest-ra study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453774/
https://www.ncbi.nlm.nih.gov/pubmed/18325087
http://dx.doi.org/10.1186/ar2383
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