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Rheumatology Advance Access originally published online on August 20, 2009
Rheumatology 2009 48(10):1309-1313; doi:10.1093/rheumatology/kep252
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies

Christophe Meune1, Emmanuel Touzé2, Ludovic Trinquart3 and Yannick Allanore4

1Department of Cardiology, Cochin Hospital, 2Department of Neurology, Sainte Anne Hospital, INSERM U894, 3Clinical Research Unit, Georges Pompidou European Hospital, and INSERM CIE 4 and 4Department of Rheumatology A, Cochin Hospital, Université Paris Descartes, Assistance Publique – Hôpitaux de Paris, Paris, France.

Correspondence to: Yannick Allanore, Department of Rheumatology A, Cochin Hospital, 27 rue du Fg St-Jacques, 75014 Paris, France. E-mail: yannick.allanore{at}cch.aphp.fr


  Abstract

Objectives. RA is known to be associated with a high cardiovascular (CV) risk. Longitudinal data suggest that RA disease course may have become milder over the past decades. Thus, we set out to estimate the magnitude of the overall increase in CV mortality associated with RA and to determine whether it has decreased over the past 50 years.

Methods. We performed a systematic review and a meta-analysis of literature in MEDLINE and EMBASE databases from January 1960 to November 2008. All cohort studies reporting CV mortality risk were included. We then calculated pooled standardized mortality ratios (SMRs) of CV mortality, and determined their evolution with time using meta-regression analysis.

Results. Seventeen studies were analysed, corresponding to a total of 91 916 patients. The overall pooled SMR was 1.6 (95% CI 1.5, 1.8; I 2 = 93%; P(het) < 0.0001). Mid-cohort year ranged from 1945 to 1995 (<1980, seven studies; 1980–90, five studies; >1990, five studies). Meta-regression analyses revealed neither any trend in SMR over time (P = 0.784) nor any relation with disease duration at the time of inclusion (P = 0.513).

Conclusions. Our results show that RA is associated with a 60% increase in risk of CV death compared with general population. Despite changes in RA course over the past decades, SMR for CV death has not changed. This suggests that targeting a reduction in CV mortality should still be considered as a major issue in RA.

KEY WORDS: Rheumatoid arthritis, Cardiovascular mortality

Submitted 26 January 2009; revised version accepted 20 July 2009.
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