류마티스관절염 환자의 심혈관 질환 및 당뇨병 위험분석: a propensity score analysis
The Risk of Cardiovascular Disease and Diabetes in Rheumatoid Arthritis Patients: A Propensity Score Analysis
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease that manifests as joint damage or athletic disability via sustained inflammation of the synovial membrane. The risk of cardiovascular disease (CVD) is higher in RA patients. This study aimed at evaluating the association between CVD comorbidities and RA by comparing a pharmacotherapy group with a nonpharmacotherapy group. Methods: Patient sample data from the Health Insurance Review and Assessment Service (HIRA-NPS- 2016) were used. Inverse probability of treatment weighting (IPTW) using the propensity score was used to minimize the differences in patient characteristics. Logistic regression analysis was used to evaluate the risk of CVD comorbidities. Results: The analyses included 1,207,213 patients, of which 33,122 (2.8%) had RA. The odds ratios (OR) of CVD comorbidities were increased in RA patients; ischemic heart disease (IHD: OR 1.75; 95% CI 1.73, 1.77), cerebral infarction (CERI: OR 1.28; 95% CI 1.26, 1.30), hypertension (HTN: OR 1.44; 95% CI 1.43, 1.45), diabetes mellitus (DM: OR 2.04; 95% CI 2.03, 2.06), and dyslipidemia (DL: OR 3.49; 95% CI 3.47, 3.51). The ORs of IHD, CERI, HTN, and DM in the traditional DMARD and biologic treatment groups were decreased, compared with those in the non-pharmacotherapy group. Conclusions: Thus, CVD risk was higher in RA patients, considering age, sex, and socioeconomic status. Appropriate pharmacotherapy could decrease the risk of CVD comorbidities in RA patients.
Abstract
Background: Rheumatoid arthritis (RA) is a systemic inflammatory disease that manifests as joint damage or athletic disability via sustained inflammation of the synovial membrane. The risk of cardiovascular disease (CVD) is higher in RA patients. This study aimed at evaluating the association between CVD comorbidities and RA by comparing a pharmacotherapy group with a nonpharmacotherapy group. Methods: Patient sample data from the Health Insurance Review and Assessment Service (HIRA-NPS- 2016) were used. Inverse probability of treatment weighting (IPTW) using the propensity score was used to minimize the differences in patient characteristics. Logistic regression analysis was used to evaluate the risk of CVD comorbidities. Results: The analyses included 1,207,213 patients, of which 33,122 (2.8%) had RA. The odds ratios (OR) of CVD comorbidities were increased in RA patients; ischemic heart disease (IHD: OR 1.75; 95% CI 1.73, 1.77), cerebral infarction (CERI: OR 1.28; 95% CI 1.26, 1.30), hypertension (HTN: OR 1.44; 95% CI 1.43, 1.45), diabetes mellitus (DM: OR 2.04; 95% CI 2.03, 2.06), and dyslipidemia (DL: OR 3.49; 95% CI 3.47, 3.51). The ORs of IHD, CERI, HTN, and DM in the traditional DMARD and biologic treatment groups were decreased, compared with those in the non-pharmacotherapy group. Conclusions: Thus, CVD risk was higher in RA patients, considering age, sex, and socioeconomic status. Appropriate pharmacotherapy could decrease the risk of CVD comorbidities in RA patients.
참고문헌 (33)
- Scott DL, "Rheumatoid arthritis", Lancet, 376, pp.1094~1108 (2010)
- Silman AJ, "Epidemiology and genetics of rheumatoid arthritis", Arthritis Res, 4(suppl), pp.S265~S272 (2002)
- Hunter TM, "Prevalence of rheumatoid arthritis in the United States adult population in healthcare claims databases, 2004-2014", Rheumatol Int, 37(9), pp.1551~1557 (2017)
- Minichiello E, "Time trends in the incidence, prevalence, and severity of rheumatoid arthritis: A systematic literature review", Joint Bone Spine, 83(6), pp.625~630 (2016)
- Naqvi AA, "Epidemiology of rheumatoid arthritis, clinical aspects and socio-economic determinants in Pakistani patients: A systematic review and meta-analysis", J Pak Med Assoc, 69, pp.389~398 (2019)
- Sandoo A, "Classical cardiovascular disease risk factors associate with vascular function and morphology in rheumatoid arthritis: a six-year prospective study", Arthritis Res Ther, 15, pp.R203~ (2013)[DOI]
- Liao KP, "Cardiovascular disease in patients with rheumatoid arthritis", Trends Cardiovasc Med, 27, pp.136~140 (2017)
- Bryant R England, "Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications", BMJ, 23(361), pp.k1036~ (2018), BMJ[DOI]
- Elke EA Arts, "Low disease activity (DAS28≤3.2) reduces the risk of first cardiovascular event in rheumatoid arthritis: a time-dependent Cox regression analysis in a large cohort study", Annals of the Rheumatic Diseases, 76(10), pp.1693~1699 (2017), BMJ[DOI]
- Solomon DH, "Disease activity in rheumatoid arthritis and the risk of cardiovascular events", Arthritis Rheumatol, 67, pp.1449~1455 (2015)
- Ljung L, "Response to biological treatment and subsequent risk of coronary events in rheumatoid arthritis", Ann Rheum Dis, 75, pp.2087~2094 (2016)
- Rempenault C, "Metabolic and cardiovascular benefits of hydroxychloroquine in patients with rheumatoid arthritis: a systematic review and meta-analysis", Ann Rheum Dis, 77(1), pp.98~103 (2018)
- Saag KG, "American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis", Arthritis Rheum, 59, pp.762~784 (2008)
- Singh JA, "2015 American College of Rheumatology Guideline for the treatment of rheumatoid arthritis", Arthritis Care Res (Hoboken), 68(1), pp.1~25 (2016)
- Singh JA, "2012 Update of the 2008American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis", Arthritis Care Res, 64, pp.625~639 (2012)
- Micha R, "Systematic review and meta-analysis of methotrexate use and risk of cardiovascular disease", Am J Cardiol, 108(9), pp.1362~1370 (2011)
- O'Neill F, "Anti-inflammatory treatment improves high-density lipoprotein function in rheumatoid arthritis", Heart, 103, pp.766~773 (2017)
- Agca R, "EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders:2015", 2016 update, 2017, pp.76, 17~28
- Boo S, "Knowledge and perception of cardiovascular disease risk among patients with rheumatoid arthritis", PLoS One, 12, pp.e0176291~ (2017)
- Kim L, "A guide for the utilization of Health Insurance Review and Assessment Service National Patient Samples", Epidemiol Health, 36, pp.e2014008~ (2014)
- Robertson J, "Changes in lipid levels with inflammation and therapy in RA: a maturing paradigm", Nat Rev Rheumatol, 9, pp.513~523 (2013)
- van Sijl AM, "The effect of TNF-alpha blocking therapy on lipid levels in rheumatoid arthritis: a metaanalysis", Semin Arthritis Rheum, 41, pp.393~400 (2011)
- Choi HK, "Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study", Lancet, 359, pp.1173~1177 (2002)
- Greenberg JD, "Tumour necrosis factor antagonist use and associated risk reduction of cardiovascular events among patients with rheumatoid arthritis", Ann Rheum Dis, 70, pp.576~582 (2011)
- Barnabe C, "Systematic review and metaanalysis:anti-tumor necrosis factor α therapy and cardiovascular events in rheumatoid arthritis", Arthritis Care Res (Hoboken), 63, pp.522~529 (2011)
- Dierkes J, "Effect of drugs on homocysteine concentrations", Semin Vasc Med, 5, pp.124~139 (2005)
- Merkle CJ, "Methotrexate causes apoptosis in postmitotic endothelial cells", Biol Res Nurs, 2, pp.5~14 (2000)
- Lim DT, "Cardiovascular risk and the use of biologic agents in rheumatoid arthritis", Curr Rheumatol Rep, 16, pp.459~ (2014)
- Aviña-Zubieta JA, "Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies", Arthritis Rheum, 59, pp.1690~1697 (2008)
- Nicola PJ, "Contribution of congestive heart failure and ischemic heart disease to excess mortality in rheumatoid arthritis", Arthritis Rheum, 54, pp.60~67 (2006)
- Schmidt TJ, "Cardiovascular Disease Prevention in Rheumatoid Arthritis: Compliance with Diabetes Screening Guidelines", J Rheumatol, 45, pp.1367~1374 (2018)
- Austin PC, "Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies", Stat Med, 34(28), pp.3661~3679 (2015)
- Glynn RJ, "Indications for propensity scores and review of their use in pharmacoepidemiology", Basic Clin Pharmacol Toxicol, 98(3), pp.253~259 (2006)