Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Recently cholesterol treatment guidelines recommend that diabetes (DM) should be considered a CVD risk equivalent to a history of coronary heart disease (CHD). Despite the well-recognized increased CVD risk in rheumatoid arthritis (RA) patients, the guidelines do not recommend that RA should be considered a CHD risk equivalent. We compared the incidence of hospitalized acute myocardial infarction (MI) among patients with DM alone, RA alone, both conditions and neither of them.
Methods: Using a mix of private and public health plans claims data from 2006 to 2010 with medical and pharmacy coverage; we identified 4 mutually exclusive cohorts: patients with 1) RA and DM; 2) RA only; 3) DM only; 4) Neither RA nor DM. Patients with prevalent CHD during a baseline period of ≥ 1 year were excluded. Acute MI was defined as ≥ 1 inpatient hospital claim with a discharge ICD-9 code in any position for 410.x (excluding 410.x2) and at least one overnight stay, unless the patient died. We compared the age- and gender-specific incidence rates (IRs) of acute MI across the four cohorts and calculated differences in IRs between select cohorts.
Results: We identified 1,070,212 eligible participants in our study. MI IRs were highest among adults with both RA and DM, followed by those with DM alone, with RA alone, and lowest in those without either condition. Findings were consistent for both sexes and across all age strata (Table). Among women 41 years of age or older, the absolute difference in IRs between the two cohorts peaked at 4.3 cases per 1,000 Person-Years (PYs) among those 71 or older. Among men, the peak difference (4.61 cases per 1,000 PYs) was observed among those 51-60 years of age. We found large increases in MI IR among RA patients if they were also diagnosed with DM, especially among women with the greatest difference (9.3 cases per 1,000 PYs) observed among women 51-60 years of age.
Conclusion: In this analysis, the incidence of MI was consistently lower in patients with RA alone than in those with DM alone, which does not support RA as a CHD risk equivalent. Our findings have important clinical implications in the treatment of hyperlipidemia for RA patients.
Table: Comparison of Age- and Gender-Specific MI Risk between Patients with RA, Diabetes (DM) and Both to Healthy Patients
|
|
Both DM and RA |
DM Only |
RA Only |
Neither DM Nor RA |
Risk Difference |
|||||
|
Age group |
# Person-Years (PYs) |
MI Incidence Rate (IR*) |
PYs |
MI IR* |
PYs |
MI IR* |
PYs |
MI IR* |
DM Alone – RA Alone |
DM and RA – RA Alone |
|
Female |
|
|
|
|
|
|
|
|
|
|
|
41-50 |
754 |
5.31 |
16453 |
3.95 |
6138 |
1.96 |
73179 |
0.85 |
1.99 |
3.35 |
|
51-60 |
1923 |
11.96 |
32431 |
6.08 |
10558 |
2.65 |
84338 |
1.64 |
3.43 |
9.31 |
|
61-70 |
3400 |
11.47 |
61620 |
8.10 |
18410 |
5.81 |
141474 |
3.13 |
2.29 |
5.66 |
|
71-85 |
4038 |
18.08 |
106349 |
15.95 |
25474 |
11.66 |
300340 |
8.24 |
4.29 |
6.42 |
|
Male |
|
|
|
|
|
|
|
|
0 |
|
|
41-50 |
215 |
4.65 |
17393 |
4.37 |
1522 |
2.63 |
63340 |
1.60 |
1.74 |
2.02 |
|
51-60 |
459 |
4.36 |
28154 |
7.71 |
2583 |
3.10 |
70147 |
2.87 |
4.61 |
1.26 |
|
61-70 |
997 |
11.03 |
47776 |
10.09 |
4257 |
7.75 |
107472 |
4.96 |
2.34 |
3.28 |
|
71-85 |
928 |
20.48 |
54639 |
16.93 |
4898 |
13.68 |
159464 |
10.10 |
3.25 |
6.8 |
*Incidence rate, per 1,000 person-years
Disclosure:
J. Zhang,
None;
S. Yang,
None;
L. Chen,
None;
F. Xie,
None;
H. Yun,
Amgen,
2;
P. M. Muntner,
Amgen,
2,
Amgen,
5;
E. Levitan,
Amgen,
2;
M. Safford,
Amgen,
2,
diaDexus, Inc.,
5;
K. G. Saag,
None;
J. A. Singh,
Savient,
2,
Takeda,
2,
Degeneron,
5,
Allergan ,
5;
J. R. Curtis,
Roche, Genentech, UCB Pharma, Janssen, CORRONA, Amgen, Pfizer, BMS, Crescendo, AbbVie,
2,
Roche, Genentech, UCB Pharma, Janssen, CORRONA, Amgen, Pfizer, BMS, Crescendo, AbbVie,
5.
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