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J Rheumatol. 2019 Mar 15. pii: jrheum.181248. doi: 10.3899/jrheum.181248. [Epub ahead of print]

Acute coronary syndrome in idiopathic inflammatory myopathies: a population-based study.

Author information

1
From the Unit of Clinical Epidemiology, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Division of Rheumatology, Jewish General Hospital, Montreal, Canada, 3Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. Dr Lundberg was supported by grants from the Swedish Research Council, the Swedish Rheumatism Association, King Gustaf V 80 Year Foundation, and the Stockholm County Council (ALF project). Dr Holmqvist was supported by grants from the Swedish Rheumatism Association, the King Gustaf V 60 Year Foundation, the Nanna Svartz Foundation, and the Stockholm County Council (ALF project). Dr Lundberg has received honoraria from Bristol Myers Squibb and MedImmune and is currently receiving a research grant from Bristol Myers Squibb and from Astra Zeneca for projects unrelated to the present manuscript. No reference is made to specific products in our work, nor do we suggest therapeutic choices in our conclusions. The other authors declare no competing interests. Address correspondence to Valérie Leclair, MD, Karolinska Institutet, Unit of Clinical Epidemiology, Karolinska Hospital T2, SE-17176, Stockholm.

Abstract

OBJECTIVE:

Evidence suggest an increased risk of cardiovascular diseases including acute coronary syndrome (ACS) in idiopathic inflammatory myopathies (IIM). The aim of this study was to investigate the risk of ACS in an incident IIM cohort compared to the general Swedish population.

METHODS:

A cohort of 655 incident IIM individuals and 6813 general population comparators were identified from national registries. IIM subjects were diagnosed from 2002 to 2011. Followup started at IIM diagnosis and corresponding date in the general population. ACS, cardiovascular comorbidities and cardiovascular risk factors were defined using ICD codes. Incidence rates including 95% confidence intervals (CI) were calculated. Cox proportional hazards models were used to compare the risk of ACS in IIM patients and the general population. The competing risk of death was accounted for using competing risk regression models.

RESULTS:

The incidence rate of ACS in IIM was higher than in the general population particularly within the first year of diagnosis and in older individuals. The overall ACS incidence rate (95% CI) in IIM was 15.6 (11.7-20.4) per 1000 person-years with a hazard ratio (95% CI) of 2.4 (1.8-3.2) compared with the general population. When accounting for the competing risk of death, the risk of ACS in IIM remained increased with a cumulative incidence of 7% at 5 years compared to 3.3% in the general population.

CONCLUSION:

IIM individuals are at higher risk of ACS particularly within the first year after diagnosis.

PMID:
30877220
DOI:
10.3899/jrheum.181248

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