Outcomes of acute cardiovascular events in rheumatoid arthritis and systemic lupus erythematosus: a population-based study

Author:

Lai Chao-Han123ORCID,Hsieh Cheng-Yang4ORCID,Barnado April5,Huang Li-Ching23,Chen Sheau-Chiann23,Tsai Liang-Miin6,Shyr Yu23,Li Chung-Yi78

Affiliation:

1. Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

2. Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN

3. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

4. Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan

5. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

6. Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan

7. Department of Public Health, College of Medicine, National Cheng Kung University, Tainan

8. Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan

Abstract

Abstract Objectives Patients with RA and SLE have an excess cardiovascular risk. We aimed to evaluate outcomes of acute cardiovascular events in these patients. Methods Using a nationwide database of Taiwan, we identified adult patients who experienced first-time acute myocardial infarction (n = 191 008), intracranial haemorrhage (n = 169 923) and ischaemic stroke (n = 486 890) over a 13-year period. Odds ratios (ORs) of in-hospital mortality and hazard ratios (HRs) of overall mortality and adverse outcomes during long-term follow-up in relation to RA and SLE were estimated with adjustment for potential confounders. Results In each cohort, 748, 410 and 1419 patients had established RA; 256, 292 and 622 patients had SLE. Among acute myocardial infarction patients, RA and SLE were associated with in-hospital mortality (RA: OR 1.61, 95% CI 1.33, 1.95; SLE: OR 2.31, 95% CI 1.62, 3.28) and overall mortality. Additionally, RA (HR 1.28, 95% CI 1.18, 1.38) and SLE (HR 1.46, 95% CI 1.27, 1.69) increased the risk of major adverse cardiac events. After intracranial haemorrhage, patients with RA and SLE had higher risks of in-hospital mortality (RA: OR 1.61, 95% CI 1.26, 2.06; SLE: OR 3.00, 95% CI 2.33, 3.86) and overall mortality. After ischaemic stroke, RA and SLE increased in-hospital mortality (RA: OR 1.45, 95% CI 1.15, 1.83; SLE: OR 2.18, 95% CI 1.57, 3.02), overall mortality and recurrent cerebrovascular events (RA: HR 1.10, 95% CI 1.002, 1.21; SLE: HR 1.31, 95% CI 1.14, 1.51), among which ischaemic stroke (HR 1.39, 95% CI 1.19, 1.62) was more likely to recur in SLE patients. Conclusion Both RA and SLE are consistently associated with adverse outcomes following acute cardiovascular events, highlighting the necessity of integrated care for affected patients.

Funder

National Cheng Kung University Hospital

NIH

Publisher

Oxford University Press (OUP)

Subject

Pharmacology (medical),Rheumatology

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