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Abstract Number: 2819

Alcohol Consumption and the Risk of Coronary Heart Disease and Mortality in Patients with Rheumatoid Arthritis

Isaac Smith1, Jie Wei2, Yuqing Zhang3, Hyon K. Choi2 and Marcy Bolster1, 1Massachusetts General Hospital, Boston, MA, 2Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, 3Department of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: alcohol use, coronary artery disease, methotrexate (MTX), morbidity and mortality and rheumatoid arthritis (RA)

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Session Information

Date: Tuesday, October 23, 2018

Session Title: 5T088 ACR Abstract: RA–DX, Manifestations, & Outcomes IV: CV Co-Morbidities (2814–2819)

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: Rheumatoid arthritis (RA) is associated with an increased risk of premature cardiovascular events and mortality. Prospective general population studies have shown moderate alcohol consumption is associated with a 25-40% reduced risk of all-cause mortality and coronary heart disease (CHD). Alcohol use has been discouraged in RA patients taking methotrexate (MTX) due to potential liver toxicity. However, a recent population-based study found moderate alcohol consumption (0-14 UK units or 0-8 US drinks per week) was not associated with a higher risk of hepatotoxicity. The aim of this study is to examine the effect of alcohol intake on all-cause mortality and CHD events among RA patients taking disease-modifying anti-rheumatic drugs (DMARDs), including those taking MTX.

Methods: A prospective cohort study (1995-2017) was conducted using electronic medical records from The Health Improvement Network (THIN) database, representative of the general United Kingdom (UK) population. Our study population consisted of RA patients taking MTX or other DMARDs. Alcohol exposure was defined as first recorded alcohol use following RA diagnosis and divided into 5 categories: non-drinkers, 1-7 units/week (mild), 8-14 units/week (moderate), 15-21 units/week (moderate-high) and >21 units/week (high), where 1 UK unit = 8g alcohol.  We created Cox-proportional hazard models using age as the time-scale and calculated hazard ratios (HR) for the relation of alcohol consumption to all-cause mortality and CHD events, adjusting for age, sex, body mass index (BMI), smoking status, and Townsend deprivation index.

Results: Of 43214 patients with RA (women: 70%, mean age: 60.2 years), 9102 deaths and 2013 CHD events occurred over 350612 person-years (mean follow-up = 8 years). Alcohol use was associated with a decreased risk of all-cause mortality in RA patients taking MTX, particularly with mild to moderate use. When the analysis was restricted to other DMARDs, the results did not change materially (Table). Alcohol consumption was also associated with a decreased risk of CHD events in both groups, most prominently with moderate-high to high use (Table). 

Conclusion: In this prospective cohort study, mild to moderate alcohol use is associated with decreased risk of all-cause mortality among RA patients taking MTX and patients taking other DMARDs. Alcohol consumption is also associated with a decreased risk of CHD events in both groups. Given these results, the prior recommendation for avoiding alcohol use in RA patients taking MTX warrants reconsideration.

Table. Relation of Alcohol Consumption to All-Cause Mortality and CHD Events in Patients with RA

Alcohol Intake

(Units/Week)†

N

Events

Event Rate (Per 1000 Person-Years)

Unadjusted HR (95% CI)

Adjusted HR‡

(95% CI)

Mortality in RA Patients Taking MTX

0

13157

2283

25.39

1.00 (Reference)

1.00 (Reference)

1-7

5244

797

19.44

0.88 (0.82 ─ 0.96)

0.90 (0.82 ─ 0.99)

8-14

1747

202

17.18

0.80 (0.69 ─ 0.92)

0.69 (0.58 ─ 0.82)

15-21

633

82

18.93

0.92 (0.74 ─ 1.15)

0.80 (0.62 ─ 1.03)

>21

586

94

22.20

1.35 (1.10 ─ 1.66)

1.03 (0.81 ─ 1.32)

Mortality in RA Patients Taking Other DMARDs

0

18361

3785

25.39

1.00 (Reference)

1.00 (Reference)

1-7

7198

1219

19.44

0.83 (0.77 ─ 0.88)

0.82 (0.76 ─ 0.89)

8-14

2441

343

17.18

0.83 (0.74 ─ 0.93)

0.67 (0.59 ─ 0.77)

15-21

938

145

18.93

0.93 (0.79 ─ 1.10)

0.77 (0.63 ─ 0.94)

>21

893

152

22.20

1.28 (1.09 ─ 1.50)

0.95 (0.78 ─ 1.15)

CHD Events in RA Patients Taking MTX

0

12625

516

5.03

1.00 (Reference)

1.00 (Reference)

1-7

5045

196

4.46

0.91 (0.77 – 1.08)

0.89 (0.73 – 1.09)

8-14

1669

74

5.55

1.19 (0.93 – 1.52)

0.98 (0.74 – 1.31)

15-21

602

22

4.55

0.96 (0.62 – 1.46)

0.48 (0.28 – 0.85)

>21

566

21

4.76

1.06 (0.68 – 1.64)

0.48 (0.28 – 0.85)

CHD Events in RA Patients Taking Other DMARDs

0

17572

752

5.37

1.00 (Reference)

1.00 (Reference)

1-7

6913

265

4.46

0.86 (0.75 ─ 0.99)

0.80 (0.68 ─ 0.95)

8-14

2337

96

5.14

1.05 (0.85 ─ 1.30)

0.85 (0.67 ─ 1.09)

15-21

895

35

4.91

0.99 (0.70 ─ 1.39)

0.51 (0.33 ─ 0.80)

>21

864

36

5.56

1.18 (0.84 ─ 1.64)

0.57 (0.37 ─ 0.87)

†Units based on standard UK measures where 1 unit = 8g alcohol. By US standards, 4 drinks = 7 UK units

‡Adjusted for age, sex, BMI, smoking status, and Townsend deprivation index


Disclosure: I. Smith, Resident Preceptorship Grant from the Rheumatology Research Foundation, 2; J. Wei, None; Y. Zhang, None; H. K. Choi, Takeda, Selecta, Kowa, and Horizon, 5,Selecta and Horizon, 2; M. Bolster, None.

To cite this abstract in AMA style:

Smith I, Wei J, Zhang Y, Choi HK, Bolster M. Alcohol Consumption and the Risk of Coronary Heart Disease and Mortality in Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/alcohol-consumption-and-the-risk-of-coronary-heart-disease-and-mortality-in-patients-with-rheumatoid-arthritis/. Accessed January 21, 2021.
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