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Martín-Martínez MA, Castañeda S, Sánchez-Alonso F, García-Gómez C, González-Juanatey C, Sánchez-Costa JT, Belmonte-López MA, Tornero-Molina J, Santos-Rey J, Sánchez González CO, Quesada E, Moreno-Gil MP, Cobo-Ibáñez T, Pinto-Tasnde JA, Babío-Herráez J, Bonilla G, Juan-Mas A, Manero-Ruiz FJ, Romera-Baurés M, Bachiller-Corral J, Chamizo-Carmona E, Uriarte-Ecenarro M, Barbadillo C, Fernández-Carballido C, Aurrecoechea E, Möller-Parrera I, Llorca J, González-Gay MA. Cardiovascular mortality and cardiovascular event rates in patients with inflammatory rheumatic diseases in the CARdiovascular in rheuMAtology (CARMA) prospective study—results at 5 years of follow-up. Rheumatology (Oxford) 2020; 60:2906-2915. [DOI: 10.1093/rheumatology/keaa737] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/21/2020] [Indexed: 12/22/2022] Open
Abstract
Abstract
Objectives
To determine cardiovascular (CV) mortality and incidence of the first CV event (CVE) in patients with chronic inflammatory rheumatic diseases (CIRD) after 5 years of follow-up.
Methods
This is an analysis of the CARdiovascular in rheMAatology (CARMA) study after 5 years of follow-up. It includes patients with RA (n = 775), AS (n = 738) and PsA (n = 721), and individuals without CIRD (n = 677) attending outpatient rheumatology clinics from 67 public hospitals in Spain. Descriptive analyses were performed for the CV mortality at 5 years. The Systematic COronary Risk Evaluation (SCORE) function at 5 years was calculated to determine the expected risk of CV mortality. Poisson models were used to estimate the incidence rates of the first CVE. Hazard ratios of the risk factors involved in the development of the first CVE were evaluated using the Weibull proportional hazard model.
Results
Overall, 2382 subjects completed the follow-up visit at 5 years. Fifteen patients died due to CVE. CV deaths observed in the CIRD cohort were lower than that predicted by SCORE risk charts. The highest incidence rate of CVE [7.39 cases per 1000 person-years (95% CI 4.63, 11.18)] was found in PsA patients. However, after adjusting for age, sex and CV risk factors, AS was the inflammatory disease more commonly associated with CVE at 5 years [hazard ratio 4.60 (P =0.02)], compared with those without CIRD.
Conclusions
Cardiovascular mortality in patients with CIRD at 5 years of follow-up is lower than estimated. Patients with AS have a higher risk of developing a first CVE after 5 years of follow-up.
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Affiliation(s)
| | - Santos Castañeda
- Division of Rheumatology, Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain
- Cátedra UAM-ROCHE, EPID-Future, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | | | - Carmen García-Gómez
- Division of Rheumatology, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | | | | | | | - Jesús Tornero-Molina
- Division of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - José Santos-Rey
- Division of Rheumatology, Hospital Virgen de la Salud, Toledo, Spain
| | | | - Estefanía Quesada
- Division of Rheumatology, Hospital Universitario Vall D’Hebron, Barcelona, Spain
| | - María P Moreno-Gil
- Division of Rheumatology, Complejo Hospitalario de Cáceres, Cáceres, Spain
| | - Tatiana Cobo-Ibáñez
- Division of Rheumatology, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - José A Pinto-Tasnde
- Division of Rheumatology, Complejo Hospitalario Universitario A Coruña, Spain
| | | | - Gema Bonilla
- Division of Rheumatology, Hospital Universitario de La Paz, Madrid, Spain
| | - Antonio Juan-Mas
- Division of Rheumatology, Hospital Sont Llatzer, Palma de Mallorca, Spain
| | | | | | | | | | - Mirem Uriarte-Ecenarro
- Division of Rheumatology, Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain
| | - Carmen Barbadillo
- Division of Rheumatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Elena Aurrecoechea
- Division of Rheumatology, Hospital U. Sierrallana, Torrelavega, Santander, Spain
| | | | - Javier Llorca
- Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria and CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain
| | - Miguel A González-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Santander, Spain, Spain
- School of Physiology, Faculty of Health Sciences, Cardiovascular Pathophysiology and Genomics Research Unit, University of the Witwatersrand, South Africa
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Martín-Martínez MA, Castañeda S, González-Juanatey C, Sánchez-Alonso F, García-Gómez C, López-González R, Babío-Herraiz J, Juan-Mas A, Moreno-Gil MP, Sánchez-González CO, Romera-Baurés M, Pinto-Tasende JA, Tornero-Molina J, Fábregas-Canales D, Llorca J, González-Gay MA. Incidence of first cardiovascular event in Spanish patients with inflammatory rheumatic diseases: prospective data from the CARMA project. Clin Exp Rheumatol 2019; 37:731-739. [PMID: 30620291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To determine the incidence and risk factors of first cardiovascular event (CVE) in patients with chronic inflammatory rheumatic diseases (CIRD). METHODS Analysis of data after 2.5 years of follow-up from the prospective study CARMA project, that includes patients with CIRD [rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA)] and matched individuals without CIRD from 67 hospitals in Spain. CVE cumulative incidence per 1000 patients was calculated after 2.5 years from the start of the project. Weibull proportional hazard model was used to calculate hazard ratio (HR) and 95% confidence interval (95% CI) of the risk factors. RESULTS 2595 (89.1%) patients completed the 2.5 years of follow-up visit. Cumulative incidence of CVE in patients with CIRD was 15.30 cases per 1000 patients (95% CI: 12.93-17.67), being higher in the subgroup with AS; 22.03 (95% CI: 11.01-33.04). Patients with AS (HR: 4.11; 95% CI: 1.07-15.79), those with older age (HR: 1.09; 95% CI: 1.05-1.13), systolic hypertension (HR: 1.02; 95% CI: 1.00-1.04) and long duration of the disease (HR: 1.07; 95% CI: 1.03-1.12) were at higher risk of first CVE during the 2.5 years of follow-up. In contrast, female gender was a protective factor (HR: 0.43; 95% CI: 0.18-1.00). CONCLUSIONS Among CIRD patients prospectively followed-up at rheumatology outpatient clinics, those with AS show higher risk of first CVE. Besides cardiovascular risk factors, such as hypertension, being a man and older as well as having a long disease duration increase the risk of CVE in patients with CIRD.
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Affiliation(s)
| | - Santos Castañeda
- Division of Rheumatology, Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain
| | | | | | | | - Ruth López-González
- Division of Rheumatology, Hospital General Virgen de la Concha, Zamora, Spain
| | | | - Antonio Juan-Mas
- Division of Rheumatology, Hospital Son Llatzer, Palma de Mallorca, Spain
| | - María P Moreno-Gil
- Division of Rheumatology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | | | | | - José A Pinto-Tasende
- Division of Rheumatology, Complejo Hospitalario A Coruña, Xubias de Arriba, A Coruña, Spain
| | | | | | - Javier Llorca
- Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria and CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain
| | - Miguel A González-Gay
- Div. Rheumatology, Univ. Cantabria, Hosp. Univ. Marqués de Valdecilla, Santander; Epidemiology, Genetics and Atherosclerosis Res. Group on Systemic Inflammatory Diseases, Rheumatology Div., IDIVAL, Santander, Spain; Univ.of the Witwatersrand, South Africa
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