Tags

Type your tag names separated by a space and hit enter

Glucocorticoids and cardiovascular events in rheumatoid arthritis: a population-based cohort study.
Arthritis Rheum. 2007 Mar; 56(3):820-30.AR

Abstract

OBJECTIVE

To determine the relationship between glucocorticoid exposure and cardiovascular (CV) events in patients with rheumatoid arthritis (RA).

METHODS

A total of 603 adult residents of Rochester, Minnesota with incident RA between 1955 and 1995 were followed up through their medical records for a median of 13 years (total of 9,066 person-years). Glucocorticoid exposure was defined 3 ways: tertiles of cumulative exposure; recent use (< or =3 months) versus past use (>3 months); and average daily dosage (< or =7.5 mg/day or >7.5 mg/day). CV events, including myocardial infarction, heart failure, and death from CV causes, were defined according to validated criteria. Cox regression models were adjusted for demographic features, CV risk factors, and RA characteristics.

RESULTS

Rheumatoid factor (RF)-negative patients with exposure to glucocorticoids were not at increased risk of CV events, irrespective of the glucocorticoid dosage or timing of use, as compared with the reference group of RF-negative patients who had never been exposed to glucocorticoids. In contrast, RF-positive patients were at increased risk of CV events, particularly with higher cumulative exposure, higher average daily dosage, and recent use of glucocorticoids. RF-positive patients with high cumulative exposure to glucocorticoids had a 3-fold increased risk of CV events (hazard ratio 3.06 [95% confidence interval 1.81-5.18]), whereas RF-negative patients with high cumulative exposure were not at increased risk (hazard ratio 0.85 [95% confidence interval 0.39-1.87]).

CONCLUSION

RF-positive but not RF-negative patients were at increased risk of CV events following exposure to glucocorticoids. These findings suggest that glucocorticoids interact with RF status to modulate the occurrence of CV events in patients with RA. The mechanisms underlying this interaction are unknown and should be the subject of further research.

Authors+Show Affiliations

Mayo Clinic, Rochester, Minnesota 55905, USA. davis.john4@mayo.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17330254

Citation

Davis, John M., et al. "Glucocorticoids and Cardiovascular Events in Rheumatoid Arthritis: a Population-based Cohort Study." Arthritis and Rheumatism, vol. 56, no. 3, 2007, pp. 820-30.
Davis JM, Maradit Kremers H, Crowson CS, et al. Glucocorticoids and cardiovascular events in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum. 2007;56(3):820-30.
Davis, J. M., Maradit Kremers, H., Crowson, C. S., Nicola, P. J., Ballman, K. V., Therneau, T. M., Roger, V. L., & Gabriel, S. E. (2007). Glucocorticoids and cardiovascular events in rheumatoid arthritis: a population-based cohort study. Arthritis and Rheumatism, 56(3), 820-30.
Davis JM, et al. Glucocorticoids and Cardiovascular Events in Rheumatoid Arthritis: a Population-based Cohort Study. Arthritis Rheum. 2007;56(3):820-30. PubMed PMID: 17330254.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glucocorticoids and cardiovascular events in rheumatoid arthritis: a population-based cohort study. AU - Davis,John M,3rd AU - Maradit Kremers,Hilal, AU - Crowson,Cynthia S, AU - Nicola,Paulo J, AU - Ballman,Karla V, AU - Therneau,Terry M, AU - Roger,Véronique L, AU - Gabriel,Sherine E, PY - 2007/3/3/pubmed PY - 2007/4/14/medline PY - 2007/3/3/entrez SP - 820 EP - 30 JF - Arthritis and rheumatism JO - Arthritis Rheum VL - 56 IS - 3 N2 - OBJECTIVE: To determine the relationship between glucocorticoid exposure and cardiovascular (CV) events in patients with rheumatoid arthritis (RA). METHODS: A total of 603 adult residents of Rochester, Minnesota with incident RA between 1955 and 1995 were followed up through their medical records for a median of 13 years (total of 9,066 person-years). Glucocorticoid exposure was defined 3 ways: tertiles of cumulative exposure; recent use (< or =3 months) versus past use (>3 months); and average daily dosage (< or =7.5 mg/day or >7.5 mg/day). CV events, including myocardial infarction, heart failure, and death from CV causes, were defined according to validated criteria. Cox regression models were adjusted for demographic features, CV risk factors, and RA characteristics. RESULTS: Rheumatoid factor (RF)-negative patients with exposure to glucocorticoids were not at increased risk of CV events, irrespective of the glucocorticoid dosage or timing of use, as compared with the reference group of RF-negative patients who had never been exposed to glucocorticoids. In contrast, RF-positive patients were at increased risk of CV events, particularly with higher cumulative exposure, higher average daily dosage, and recent use of glucocorticoids. RF-positive patients with high cumulative exposure to glucocorticoids had a 3-fold increased risk of CV events (hazard ratio 3.06 [95% confidence interval 1.81-5.18]), whereas RF-negative patients with high cumulative exposure were not at increased risk (hazard ratio 0.85 [95% confidence interval 0.39-1.87]). CONCLUSION: RF-positive but not RF-negative patients were at increased risk of CV events following exposure to glucocorticoids. These findings suggest that glucocorticoids interact with RF status to modulate the occurrence of CV events in patients with RA. The mechanisms underlying this interaction are unknown and should be the subject of further research. SN - 0004-3591 UR - https://www.unboundmedicine.com/medline/citation/17330254/Glucocorticoids_and_cardiovascular_events_in_rheumatoid_arthritis:_a_population_based_cohort_study_ DB - PRIME DP - Unbound Medicine ER -