Introduction
Materials and methods
Clinical evaluation
Patient self-report
Statistical analyses
Results
Patients
Country | Number of sites | Number of patients | Age in years (mean) | Female (%) | Years of education (mean) | Disease duration in years (mean) | RF-positive (%) | Extra-articular diseasea (%) | Cardiovascular events (all)b (%) |
---|---|---|---|---|---|---|---|---|---|
Denmark | 3 3 | 301 | 58 | 76 | 11 | 12 | 74 | 34 | 9.97 |
Finland | 3 | 304 | 59 | 72 | 10 | 13 | 75 | 18 | 11.18 |
France | 4 | 389 | 55 | 78 | 11 | 13 | 75 | 21 | 3.60 |
Germany | 3 | 225 | 59 | 84 | 10 | 13 | 61 | 36 | 17.78 |
Ireland | 3 | 225 | 57 | 64 | 11 | 11 | 81 | 30 | 6.67 |
Italy | 4 | 336 | 61 | 78 | 8 | 10 | 73 | 13 | 8.93 |
Netherlands | 3 | 317 | 59 | 68 | 11 | 9 | 69 | 13 | 9.46 |
Poland | 7 | 642 | 53 | 86 | 12 | 11 | 71 | 33 | 11.84 |
Spain | 3 | 301 | 60 | 74 | 10 | 11 | 71 | 23 | 9.97 |
Sweden | 3 | 248 | 59 | 72 | 10 | 12 | 82 | 23 | 8.47 |
UK | 3 | 126 | 60 | 78 | 12 | 15 | 84 | 30 | 10.32 |
Turkey | 3 | 309 | 52 | 85 | 7 | 11 | 69 | 18 | 6.80 |
Serbia | 1 | 100 | 59 | 88 | 8 | 10 | 71 | 23 | 9.00 |
USA | 3 | 294 | 57 | 72 | 14 | 9 | 70 | 24 | 11.56 |
Argentina | 2 | 246 | 51 | 90 | 9 | 10 | 90 | 26 | 3.66 |
Total | 48 | 4,363 | 57 ± 1 | 78 | 10 ± 4 | 11 ± 9 | 73.7 | 24.3 | 9.31 |
Cardiovascular morbidity
Male | Female | |||
---|---|---|---|---|
Mean/% | 95% CI | Mean/% | 95% CI | |
Myocardial infarctiona | 8 | 6–10 | 2 | 1–2 |
Strokeb | 3 | 2–4 | 2 | 1–2 |
Cardiovascular (all)a,c | 16 | 14–18 | 7 | 7–8 |
Age in yearsa | 58.9 | 58.1–59.7 | 56.3 | 55.8–56.7 |
Disease duration in yearsa | 8.8 | 8.2–9.4 | 10.0 | 9.7–10.3 |
Rheumatoid factor-positive | 74 | 71–76 | 72 | 70–73 |
Hypertension | 31 | 28–34 | 32 | 31–34 |
Hyperlipidemia | 13 | 11–16 | 14 | 13–15 |
Diabetes mellitusb | 10 | 8–12 | 7 | 6–8 |
Smoking evera | 68 | 65–71 | 37 | 35–38 |
Smoking nowa | 26 | 23–29 | 15 | 14–17 |
Body mass index ≥30a | 13 | 11–15 | 19 | 18–20 |
Physical inactivityd | 68 | 65–71 | 73 | 72–75 |
Traditional cardiovascular risk factors
Cardiovascular morbidity (percentage of patients) | |||||
---|---|---|---|---|---|
No | Yes | Hazard ratio | 95% CI | P value | |
Rheumatoid variables | |||||
Rheumatoid factor | 71.7 | 77.0 | 1.02 | 0.76–1.37 | 0.881 |
Extra-articular diseasea | 23.0 | 43.3 | 1.52 | 1.19–1.95 | 0.001 |
Traditional risk factors | |||||
Age in years (mean) | 55.8 | 66.4 | 1.05 | 1.04–1.06 | 0.000 |
Gender (female) | 79.4 | 64.0 | 0.42 | 0.33–0.54 | 0.000 |
Hypertension | 28.7 | 62.9 | 2.97 | 2.31–3.83 | 0.000 |
Hyperlipidemia | 11.3 | 34.0 | 3.19 | 2.47–4.13 | 0.000 |
Diabetes | 6.9 | 15.8 | 2.09 | 1.50–2.92 | 0.000 |
Smoking ever | 42.6 | 51.2 | 1.60 | 1.25–2.04 | 0.000 |
Smoking now | 18.3 | 11.8 | 0.80 | 0.55–1.18 | 0.260 |
Obesity | 17.5 | 18.3 | 1.34 | 0.96–1.86 | 0.082 |
Physical inactivity | 71.9 | 73.5 | 1.00 | 0.75–1.33 | 0.993 |
Cardiovascular events (all)a hazard ratio (95% CI) | |||
---|---|---|---|
All countries | Countries with high prevalence | Countries with low prevalence | |
Age | 1.04 (1.03–1.06)b | 1.05 (1.03–1.07)b | 1.04 (1.01–1.06)c |
Gender (female) | 0.49 (0.36–0.66)b | 0.45 (0.31–0.66)b | 0.55 (0.32–0.94)c |
Rheumatoid factor | 0.95 (0.68–1.33) | 0.95 (0.64–1.41) | 0.90 (0.46–1.73) |
Extra-articular disease | 1.33 (1.00–1.78) | 1.28 (0.92–1.80) | 1.60 (0.91–2.84) |
Hypertension | 1.95 (1.44–2.63)b | 1.85 (1.29–2.64)c | 2.23 (1.28–3.90)c |
Hyperlipidemia | 2.41 (1.78–3.27)b | 2.16 (1.50–3.10)b | 3.24 (1.86–5.65)b |
Diabetes | 1.34 (0.92–1.96) | 1.05 (0.65–1.69) | 2.20 (1.18–4.09)c |
Ever-smoking | 1.56 (1.16–2.12)c | 1.46 (1.01–2.11)d | 1.88 (1.10–3.22)c |
Obesity | 1.16 (0.81–1.66) | 1.52 (1.01–2.27)d | 0.57 (0.25–1.28) |
Physical inactivity | 0.93 (0.67–1.30) | 1.11 (0.75–1.65) | 0.61 (0.33–1.10) |
Myocardial infarction hazard ratio (95% CI) | |||
All countries | Countries with high prevalence | Countries with low prevalence | |
Age | 1.05 (1.02–1.08)c | 1.04 (1.01–1.08)c | 1.06 (1.00–1.13)c |
Gender (female) | 0.46 (0.27–0.80)c | 0.55 (0.29–1.06) | 0.37 (0.13–1.04) |
Rheumatoid factor | 0.68 (0.36–1.31) | 0.68 (0.31–1.48) | 0.82 (0.23–2.91) |
Extra-articular disease | 2.26 (1.29–3.97)c | 2.26 (1.17–4.37)c | 2.13 (0.71–6.35) |
Hypertension | 1.45 (0.83–2.53) | 1.10 (0.57–2.15) | 2.19 (0.72–6.71) |
Hyperlipidemia | 3.51 (1.98–6.21)b | 3.51 (1.80–6.84)b | 4.34 (1.41–13.33)c |
Diabetes | 1.18 (0.59–2.38) | 1.27 (0.56–2.90) | 1.01 (0.24–4.29) |
Ever-smoking | 3.20 (1.74–5.90)b | 2.47 (1.22–4.99)c | 12.14 (2.50–59.05)c |
Obesity | 0.74 (0.34–1.62) | 0.59 (0.22–1.57) | 1.36 (0.37–5.01) |
Physical inactivity | 0.88 (0.46–1.65) | 0.96 (0.45–2.07) | 0.87 (0.24–3.12) |
Stroke hazard ratio (95% CI) | |||
All countries | Countries with high prevalence | Countries with low prevalence | |
Age | 1.02 (0.99–1.05) | 1.03 (1.00–1.06) | 0.99 (0.93–1.05) |
Gender (female) | 0.59 (0.31–1.12) | 0.66 (0.31–1.42) | 0.37 (0.10–1.39) |
Rheumatoid factor | 0.95 (0.45–2.00) | 0.88 (0.38–2.06) | 2.67 (0.40–17.71) |
Extra-articular disease | 1.41 (0.77–2.58) | 1.43 (0.69–2.94) | 1.31 (0.40–4.30) |
Hypertension | 2.81 (1.49–5.30)c | 2.95 (1.43–6.11)c | 2.37 (0.61–9.20) |
Hyperlipidemia | 1.18 (0.60–2.31) | 0.69 (0.27–1.76) | 3.69 (1.16–11.78)c |
Diabetes | 2.23 (1.12–4.44)d | 1.70 (0.71–4.07) | 4.63 (1.31–16.40)c |
Ever-smoking | 1.66 (0.89–3.09) | 1.74 (0.82–3.69) | 1.31 (0.37–4.63) |
Obesity | 0.72 (0.31–1.68) | 0.77 (0.28–2.08) | 0.56 (0.11–2.69) |
Physical inactivity | 1.01 (0.50–2.03) | 1.30 (0.59–2.87) | 0.52 (0.13–2.09) |
Disease-modifying antirheumatic drugs and glucocorticoids
HRa (95% CI) CV all types | HRb (95% CI) CV all types | HRc (95% CI) | |||
---|---|---|---|---|---|
CV all types | Myocardial infarction | Stroke | |||
Methotrexate | 0.82 (0.79–0.86)d | 0.84 (0.80–0.87)d | 0.85 (0.81–0.89)d | 0.82 (0.74–0.91)d | 0.89 (0.82–0.98)e |
Glucocorticoids | 0.94 (0.92–0.97)d | 0.95 (0.93–0.97)d | 0.95 (0.92–0.98)d | 0.96 (0.91–1.00) | 0.98 (0.93–1.03) |
Antimalarials | 0.94 (0.91–0.98)f | 0.95 (0.91–0.99)f | 0.98 (0.94–1.02) | 0.94 (0.85–1.03) | 0.87 (0.76–1.01) |
Sulfasalazine | 0.91 (0.87–0.96)d | 0.92 (0.88–0.97)f | 0.92 (0.87–0.98)f | 0.82 (0.69–0.98)e | 0.90 (0.79–1.03) |
Gold | 0.96 (0.92–1.00)e | 0.96 (0.92–1.00)e | 0.99 (0.95–1.03) | 1.04 (0.98–1.10) | 0.98 (0.89–1.07) |
Leflunomide | 0.52 (0.38–0.72)d | 0.55 (0.41–0.75)d | 0.59 (0.43–0.79)f | 0.52 (0.26–1.06) | 0.91 (0.65–1.28) |
TNF-α blockers | 0.67 (0.53–0.85)f | 0.71 (0.56–0.89)f | 0.64 (0.49–0.83)f | 0.42 (0.21–0.81)e | 0.64 (0.39–1.05) |