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The Impact of Traditional Cardiovascular Risk Factors on Cardiovascular Outcomes in Patients with Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

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  • Leena R Baghdadi
  • Richard J Woodman
  • E Michael Shanahan
  • Arduino A Mangoni

Abstract

Background: Rheumatoid arthritis (RA) is known to increase the risk of cardiovascular (CV) disease. However, the individual impact of traditional CV risk factors in RA is unknown. Objective: To assess the strength of the association between individual CV risk factors and rate of either myocardial infarction (MI), combined CV morbidity (MI, angina pectoris, heart failure, stroke, and peripheral arterial disease (PAD)) or CV mortality in RA patients. Methods: RA studies reporting traditional CV risk factors [hypertension, type 2 diabetes (T2D), smoking, hypercholesterolaemia, obesity, and physical inactivity] as exposures and MI, CV morbidity (MI, angina, heart failure, stroke, and PAD combined) or CV mortality alone as outcomes were searched until March 2013 using MEDLINE, Scopus and Cochrane. Meta-analyses combined relative risk (RR) estimates from each study where either the RR and 95% confidence intervals or where raw counts were available. Results: Ten studies reporting sufficient data for inclusion into meta-analyses were identified. Relevant data was available for each risk factor and MI and CV morbidity but no studies reported on CV mortality. Risk of MI increased in RA patients with hypertension (RR 1.84, 95% CI 1.38, 2.46) and T2D (RR 1.89, 95% CI 1.36, 2.63). CV morbidity increased with hypertension (RR 2.24, 95% CI 1.42, 3.06), T2D (RR 1.94, 95% CI 1.58, 2.30), smoking (RR 1.50, 95% CI 1.15, 1.84), hypercholesterolaemia (RR 1.73, 95% CI 1.03, 2.44) and obesity (RR 1.16, 95% CI 1.03, 1.29) but not with physical inactivity (RR 1.00, 95% CI 0.71, 1.29). Conclusion: Hypertension, T2D, smoking, hypercholesterolaemia and obesity increased CV risk in patients with RA. These results highlight the importance of managing CV risk factors in RA, similarly to non-RA patients.

Suggested Citation

  • Leena R Baghdadi & Richard J Woodman & E Michael Shanahan & Arduino A Mangoni, 2015. "The Impact of Traditional Cardiovascular Risk Factors on Cardiovascular Outcomes in Patients with Rheumatoid Arthritis: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(2), pages 1-18, February.
    • Handle: RePEc:plo:pone00:0117952
    DOI: 10.1371/journal.pone.0117952
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    References listed on IDEAS

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    1. Gary S. Firestein, 2003. "Evolving concepts of rheumatoid arthritis," Nature, Nature, vol. 423(6937), pages 356-361, May.
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    1. Yukimi Otsuka & Chikako Kiyohara & Yusuke Kashiwado & Takuya Sawabe & Shuji Nagano & Yasutaka Kimoto & Masahiro Ayano & Hiroki Mitoma & Mitsuteru Akahoshi & Yojiro Arinobu & Hiroaki Niiro & Koichi Aka, 2018. "Effects of tumor necrosis factor inhibitors and tocilizumab on the glycosylated hemoglobin levels in patients with rheumatoid arthritis; an observational study," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-16, April.
    2. Leena R Baghdadi, 2020. "Effect of methotrexate use on the development of type 2 diabetes in rheumatoid arthritis patients: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-22, July.

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