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Rheumatology Advance Access originally published online on October 25, 2009
Rheumatology 2009 48(12):1600-1605; doi:10.1093/rheumatology/kep301
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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

Cardiovascular morbidity and mortality remain similar in two cohorts of patients with long-standing rheumatoid arthritis seen in 1978 and 1995 in Malmö, Sweden

Ulf Bergström1, Lennart T. H. Jacobsson1 and Carl Turesson1

1Department of Rheumatology, Malmö University Hospital, Malmö, Sweden.

Correspondence to: Ulf Bergström, Department of Rheumatology, Malmö University Hospital, S-205 02 Malmö, Sweden. E-mail: pwf626s{at}tninet.se


  Abstract

Objective. Patients with RA have an increased risk of cardiovascular disease. Management of RA has changed substantially over time. Our aim was to evaluate changes in cardiovascular morbidity and mortality over the period of 1978–2002.

Methods. Two cohorts of consecutive patients with RA seen at outpatient clinics in Malmö, Sweden, were started in 1978 (n = 148) and 1995 (n = 161) and compared with the corresponding background population. Patients were followed for 8 years, and fatal and non-fatal cardiovascular first events were identified using two national registers, hospital discharge and cause of death. Standardized morbidity ratio (SMoR) and standardized mortality ratio (SMR), adjusted for age and sex were calculated.

Results. Sex distribution, age at disease onset and disease duration were similar in both groups. The 1995 cohort was more extensively treated with DMARDs and had less disease activity and disability. Total cardiovascular morbidity was increased in the 1978 cohort (SMoR 158; 95% CI 111, 225) as well as in the 1995 cohort (SMoR 168; 95% CI 118, 232). This was mainly due to an increased risk of coronary artery disease. Overall mortality was elevated in the 1978 cohort but not in the 1995 cohort. There was no change in cardiovascular excess mortality (SMR 175; 95% CI 100, 284; and 172; 100, 276 for the two cohorts, respectively).

Conclusions. There were similar elevations in the incidence of cardiovascular comorbidity in RA patients, identified two decades apart compared with the general population, in spite of more extensive treatment and reduced disease severity in the more recent cohort.

KEY WORDS: Cardiovascular, Mortality, Morbidity, Rheumatoid arthritis, Epidemiology, DMARDs, Disability evaluation, Disease activity, Malmö, Sweden

Submitted 22 April 2009; revised version accepted 13 August 2009.
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