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Rheumatology (Oxford). 2019 Oct 10. pii: kez456. doi: 10.1093/rheumatology/kez456. [Epub ahead of print]

Outcomes of acute cardiovascular events in rheumatoid arthritis and systemic lupus erythematosus: a population-based study.

Author information

1
Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
2
Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN.
3
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
4
Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan.
5
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
6
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.
7
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan.
8
Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.

Abstract

OBJECTIVES:

Patients with RA and SLE have an excess cardiovascular risk. We aimed to evaluate outcomes of acute cardiovascular events in these patients.

METHODS:

Using a nationwide database of Taiwan, we identified adult patients who experienced first-time acute myocardial infarction (n = 191 008), intracranial haemorrhage (n = 169 923) and ischaemic stroke (n = 486 890) over a 13-year period. Odds ratios (ORs) of in-hospital mortality and hazard ratios (HRs) of overall mortality and adverse outcomes during long-term follow-up in relation to RA and SLE were estimated with adjustment for potential confounders.

RESULTS:

In each cohort, 748, 410 and 1419 patients had established RA; 256, 292 and 622 patients had SLE. Among acute myocardial infarction patients, RA and SLE were associated with in-hospital mortality (RA: OR 1.61, 95% CI 1.33, 1.95; SLE: OR 2.31, 95% CI 1.62, 3.28) and overall mortality. Additionally, RA (HR 1.28, 95% CI 1.18, 1.38) and SLE (HR 1.46, 95% CI 1.27, 1.69) increased the risk of major adverse cardiac events. After intracranial haemorrhage, patients with RA and SLE had higher risks of in-hospital mortality (RA: OR 1.61, 95% CI 1.26, 2.06; SLE: OR 3.00, 95% CI 2.33, 3.86) and overall mortality. After ischaemic stroke, RA and SLE increased in-hospital mortality (RA: OR 1.45, 95% CI 1.15, 1.83; SLE: OR 2.18, 95% CI 1.57, 3.02), overall mortality and recurrent cerebrovascular events (RA: HR 1.10, 95% CI 1.002, 1.21; SLE: HR 1.31, 95% CI 1.14, 1.51), among which ischaemic stroke (HR 1.39, 95% CI 1.19, 1.62) was more likely to recur in SLE patients.

CONCLUSION:

Both RA and SLE are consistently associated with adverse outcomes following acute cardiovascular events, highlighting the necessity of integrated care for affected patients.

KEYWORDS:

RA; SLE; acute myocardial infarction; intracranial haemorrhage; ischaemic stroke

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