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Fragility Fractures Are Associated with an Increased Risk for Cardiovascular Events in Women and Men with Rheumatoid
Orla Ni Mhuircheartaigh1,2, Cynthia S Crowson1,2, Sherine E Gabriel1,2
1From the St. Vincent's Hospital, Dublin, Ireland; Division of Biomedical Statistics and Informatics, and Division of Epidemiology, Department of Health Sciences Research, and Division of Rheumatology, and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Insights
A fragility fracture in patients with rheumatoid arthritis (RA) significantly predicts cardiovascular disease (CVD) risk in both men and women. This finding highlights the need for increased CVD screening and prevention in RA patients who experience fractures.
Area of Science:
- Rheumatology
- Cardiology
- Epidemiology
Background:
- Rheumatoid arthritis (RA) patients face elevated risks for both fragility fractures and cardiovascular disease (CVD).
- These conditions contribute to increased morbidity and mortality in RA patients.
- Fragility fractures may occur at younger ages in RA patients compared to the general population, sharing risk factors with CVD.
Purpose of the Study:
- To determine if a fragility fracture predicts the development of CVD in individuals with RA.
- To investigate this association in both women and men diagnosed with RA.
Main Methods:
- A population-based cohort study compared RA patients (1955-2007) with age- and sex-matched non-RA controls.
- Fragility fractures and CVD events were identified post-RA incidence, with risk factors modeled as time-dependent covariates.
- Cox models were used to analyze the association between fractures and subsequent CVD development.
Main Results:
- The study included 1171 subjects in both RA and non-RA cohorts.
- RA patients experienced 406 fragility fractures and 286 CVD events, while non-RA controls had 346 fractures and 225 CVD events.
- RA subjects with fragility fractures showed a significantly increased CVD risk (HR 1.81), unlike non-RA subjects (HR 1.18).
Conclusions:
- Fragility fractures in RA patients are linked to a higher risk of CVD events.
- Clinicians should use fragility fractures as an alert for intensified CVD screening and preventive strategies in RA patients.
- These findings apply to both women and men with rheumatoid arthritis.
Objective:
Women and men with rheumatoid arthritis (RA) have an increased risk for fragility fractures and cardiovascular disease (CVD), each of which has been reported to contribute to excess morbidity and mortality in these patients. Fragility fractures share similar risk factors for CVD but may occur at relatively younger ages in patients with RA. We aimed to determine whether a fragility fracture predicts the development of CVD in women and men with RA.
Methods:
We studied a population-based cohort with incident RA from 1955 to 2007 and compared it with age- and sex-matched non-RA subjects. We identified fragility fractures and CVD events following the RA incidence/index date, along with relevant risk factors. We used Cox models to examine the association between fractures and the development of CVD, in which fractures and CVD risk factors were modeled as time-dependent covariates.
Results:
There were 1171 subjects (822 women; 349 men) in each of the RA and non-RA cohorts. Over followup, there were 406 and 346 fragility fractures and 286 and 225 CVD events, respectively. The overall CVD risk was increased significantly for RA subjects following a fragility fracture (HR 1.81, 95% CI 1.38-2.37) but not for non-RA subjects (HR 1.18, 95% CI 0.85-1.63). Results were similar for women and men with RA.
Conclusion:
Fragility fractures in both women and men with RA are associated with an increased risk for CVD events and should raise an alert to clinicians to target these individuals for further screening and preventive strategies for CVD.
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