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Is Rheumatoid Arthritis a Cardiovascular Risk-Equivalent to Diabetes Mellitus?

Jeffrey R Curtis1, Shuo Yang1, Jasvinder A Singh1

  • 1University of Alabama at Birmingham.

Arthritis Care & Research
|February 7, 2018
PubMed

Insights

Patients with diabetes mellitus have a higher risk of heart attack than those with rheumatoid arthritis. Combining both conditions significantly elevates cardiovascular disease risk.

Area of Science:

  • Cardiology
  • Rheumatology
  • Endocrinology

Background:

  • The 2013 ACC/AHA guidelines recommend statins for patients aged 40-75 with diabetes mellitus due to high cardiovascular disease (CVD) risk.
  • Rheumatoid arthritis (RA) is also associated with increased CVD risk, prompting comparisons with diabetes mellitus risk.

Purpose of the Study:

  • To compare the incidence of acute myocardial infarction (MI), stroke, and coronary revascularization in patients with diabetes mellitus, RA, both, or neither condition.
  • To evaluate if RA should be considered a diabetes mellitus risk-equivalent for hyperlipidemia management.

Main Methods:

  • Retrospective cohort study using 2006-2010 health plan claims data.
  • Identified four mutually exclusive cohorts (>40 years): RA + diabetes mellitus, RA only, diabetes mellitus only, and neither.
  • Excluded patients with prevalent CVD; outcomes included MI, stroke, and coronary revascularization.

Main Results:

  • Analyzed 920,772 participants. Incidence rates (per 1,000 person-years) for MI were highest in the RA + diabetes mellitus group (12.6), followed by diabetes mellitus only (10.7), RA only (5.7), and neither (4.2).
  • Standardized incidence rates (IRs) confirmed these trends.

Conclusions:

  • While RA elevates CVD risk, it is less pronounced than the risk associated with diabetes mellitus.
  • Classifying RA as a diabetes mellitus risk-equivalent for hyperlipidemia management may not be appropriate.
Abstract

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