Incidence Of Coronary Heart Disease Associated With Arthritis: A Canadian Population-Based Cohort Study

Orit Schieir¹, S. Hogg-Johnson², Richard H Glazier³ and Elizabeth M. Badley⁴, ¹Epidemiology, University of Toronto, Toronto, ON, Canada, ²Institute for Work and Health, Toronto, ON, Canada, ³nstitute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, ⁴Division of Health Care and Outcomes Research, Toronto Western Research Institute; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Comorbidity, Heart disease, population studies and risk assessment

Session Information

Title: ARHP Epidemiology and Public Health

Session Type: Abstract Submissions (ARHP)

Background/Purpose: Several individual types of arthritis have been associated with increased coronary heart disease (CHD) morbidity in clinical studies, but whether arthritis overall increases the risk of developing CHD is unknown. The objective of the present study was to estimate the extent to which arthritis is associated with the time-to-first occurrence of CHD in a Canadian population-based sample.

Methods: The present study was a secondary analysis of the longitudinal Canadian National Population Health Survey (NPHS), a nationally representative community sample followed every 2 years from 1994/95 through 2010/11. Standardized questionnaires were administered including information on chronic conditions, socio-demographic variables and lifestyle/health behaviours. Deaths were linked to the Canadian Vital Statistics Database. Arthritis was ascertained by self-reported physician diagnosis. CHD was ascertained by self-reported physician diagnosis or death due to ischaemic heart disease (ICD-10 codes I20-I25) or heart failure (ICD-10 codes I50.0- I50.9). Additional covariate information considered in the present analysis included: age, sex, education, body mass index (BMI), smoking, physical inactivity, activity limitation, self-reported physician-diagnosed diabetes and hypertension, and sum of non-cardiovascular comorbidities. Updated values of arthritis, age, education, smoking and comorbidity count were analyzed as time-varying covariates. Discrete-time survival analysis stratified by gender was used to estimate hazard rates for incident CHD associated with arthritis.

Results: The analytical cohort included 13, 369 Canadians age 18 years or older without prevalent CHD or a past history of CHD at baseline. After adjusting for all covariates, arthritis was associated with a 75% increased risk for incident CHD in women (HR: 1.75, 95% CI: 1.39, 2.20) but was not associated with a significant increased risk for CHD in men (HR: 0.95, 95% CI: 0.74-1.22). Women with arthritis who reported concomitant activity limitation had over a 2.5 times higher risk for incident CHD than those without arthritis or activity limitation (HR: 2.55, 95% CI: 1.91, 3.38), adjusted for all covariates. Older age, being a current smoker, baseline diabetes and hypertension, higher BMI and non-cardiovascular comorbidities were also independently associated with incident CHD.

Conclusion: These Canadian population-based estimates suggest that women with arthritis have a significant increased risk for developing CHD, and that women with related activity limitation indicative of more severe arthritis may represent a particularly high-risk population. These data support considering cardiovascular prevention strategies in women with arthritis.

Disclosure:

O. Schieir,
None;

S. Hogg-Johnson,
None;

R. H. Glazier,
None;

E. M. Badley,
None.

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