Session Information
Date: Wednesday, October 24, 2018
Title: 6W025 ACR Abstract: Vasculitis–Non-ANCA-Assocd & Rel D/Os III: Clinical Subtype & Outcome(2988–2993)
Session Type: ACR Concurrent Abstract Session
Session Time: 11:00AM-12:30PM
Background/Purpose: Cardiovascular (CV) risk in chronic inflammatory diseases is increased. Polymyalgia Rheumatica (PMR) is an inflammatory condition that might have a prolonged course. Our objective was to compare incidence rates of cardiovascular events (CVE) in patients with PMR with matched controls from a university hospital-based health management organization (HMO).
Methods: PMR patients (fulfilling ACR 2012 criteria) diagnosed after the year 2000 from the HMO were identified and matched (1:2) by date of birth and sex with controls from the same HMO. Those PMR patients with CVE before PMR diagnosis were excluded. Controls with CVE before its correspondent case date of diagnosis were also excluded. Patients were followed until they voluntarily left the HMO, a CVE occurred, the end of study (May 1st 2018), or death. Electronic medical records were manually reviewed and demographic, clinical and treatment data were collected. Incidence rates per 1000 person-years (PY) of each CVE were calculated and compared between groups. A multivariate cox regression analysis was performed to identify factors associated with CVE.
Results: 868 PMR patients and 1736 controls were included and contributed 10865.2 and 12654.6 PY of follow up respectively. Patients’ characteristics are shown in table 1. PMR patients were 682 females (78.7, 95% CI 75.8-81.3) with a mean age at diagnosis of 75.2 years (SD 7.9). Overall CVE incidence rate was lower in PMR patients than controls: 10.3 per 1000 PY (95% CI 8.6-12.2) versus 14.8 per 1000 PY (95% CI 12.8-16.8) respectively, p = 0.001. Cardiovascular death was also less frequent in PMR patients than in controls: 0.6 per 1000 PY (95% CI 0.2-1.2) versus 1.9 per 1000 PY (95% CI 1.2-2.8) respectively, p=0.02. When analyzing each CVE, stroke and abdominal aneurism incidence rates were higher in controls than PMR (table 1) while other CVE were similar across groups. In the multivariate cox regression analysis, men (OR 2.2, 95% CI 1.7-2.8, p <0.001) and arterial hypertension (OR 1.5, 95% CI 1.1-1.9, p 0.003) were associated with an increased CV risk, while a PMR diagnosis was protective (OR 0.4, 95% CI 0.3-0.5).
Conclusion: Despite having more traditional cardiovascular risk factors and having been followed longer than controls, CVE were more frequent in the control group than in PMR patients. This may be due to a closer medical follow-up.
|
PMR patients (n= 868) |
PMR controls (n= 1736) |
p | |
| Female, n (%, 95% CI) | 682 (78.7, 75.8-81.3) | 10391 (80.1, 78.2-81.9) | 0.38 |
| Arterial hypertension, n (%, 95% CI) | 598 (68.1, 65.8-71.9) | 10149 (66.2, 63.9-68.4) | 0.15 |
| Diabetes, n (%, 95% CI) | 64 (7.4, 5.8-9.3) | 92 (5.3, 4.3-6.4) | 0.04 |
| Ever Smoker, n (%, 95% CI) | 194 (22.3, 19.7-25.2) | 281 (16.2, 14.5-18) | <0.001 |
| Dyslipidemia, n (%, 95% CI) | 418 (48.3, 44.9-51.6) | 532 (30.6, 28.5-32.8) | <0.001 |
| Obesity, n (%, 95% CI) | 135 (15.6, 13.3-18.1) | 113 (8.2, 7-9.6) | <0.001 |
| Aspirin user, n (%, 95% CI) | 126 (14.5, 12.3-17) | 149 (8.6, 7.3-9.9) | <0.001 |
| Thoracic aneurism, n (%, 95% CI) | 44 (5.1, 3.8-6.7) | 52 (3.0, 2.3-3.9) | 0.01 |
| Thoracic aneurism, incidence rate, per 1000 patient-years ( 95% CI) | 4.1 (3-5.4) | 4.2 (3.2-5.4) | 0.47 |
| Abdominal aneurism, n (%, 95% CI) | 1 (0.1, 0.02-0.8) | 10 (0.6, 0.3-1.1) | 0.09 |
| Abdominal aneurism, incidence rate, per 1000 patient-years (95% CI) | 0.1 (0.01-0.74) | 0.8 (0.4-1.5) | 0.01 |
| Stroke, n (%, 95% CI) | 29 (3.3, 2.3-4.8) | 76 (4.4, 3.5-5.4) | 0.21 |
| Stroke, incidence rate, per 1000 patient-years (95% CI) | 2.7 (1.9-3.9) | 6.1 (4.8-7.5) | <0.001 |
| Coronary event, n (%, 95% CI) | 30 (3.5, 2.4-4.9) | 40 (2.3, 1.7-3.1) | 0.09 |
| Coronary event, incidence rate, per 1000 patients-years (95% CI) | 2.8 (1.9-3.9) | 3.2 (2.4-4.3) | 0.28 |
| Peripheral arteriopathy, n (%, 95% CI) | 19 (2.2, 1.4-3.4) | 17 (0.9, 0.6-1.6) | 0.01 |
| Peripheral arteriopathy, incidence rate, per 1000 patients-years (95% CI) | 1.7 (1.1-2.7) | 1.3 (0.9-2.4) | 0.21 |
| Any Cardiovascular Event, n (%, 95% CI) | 112 (12.9, 10.8-15.3) | 187 (10.8, 9.4-12.3) | 0.11 |
| Any Cardiovascular Event, incidence rate, per 1000 patient-years (95% CI) | 10.3 (8.6-12.2) | 14.8 (12.8-16.8) | 0.001 |
| Cardiovascular death, n (%, 95% CI) | 6 (0.7, 0.3-1.5) | 24 (1.4, 0.9-2.1) | 0.12 |
| Cardiovascular death incidence rate per 1000 patient-years, (95% CI) | 0.6 (0.2-1.2) | 1.9 (1.2-2.8) | 0.02 |
To cite this abstract in AMA style:
Mollerach FB, Scolnik M, Rosa J, Marin Zucaro NM, Soriano ER. Do Polymyalgia Rheumatica Patients Have an Increased Risk of Cardiovascular Events?: A Matched-Control Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/do-polymyalgia-rheumatica-patients-have-an-increased-risk-of-cardiovascular-events-a-matched-control-study/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/do-polymyalgia-rheumatica-patients-have-an-increased-risk-of-cardiovascular-events-a-matched-control-study/