Session Information
Session Type: Abstract Submissions (ACR)
Title: The Association between Inflammatory Markers and Hyperlipidemia and the Risk of Myocardial Infarction in Patients with Rheumatoid Arthritis
Background/Purpose: Patients with rheumatoid arthritis (RA) are at increased risk of developing myocardial infarction (MI) which is not explained by Framingham CHD risk factors. We examined the association between RA-related inflammatory markers, hyperlipidemia and the risk of MI in RA patients.
Methods: We conducted a retrospective cohort study of RA patients using administrative claims data from a large U.S. commercial health plan from 2005 to 2010. Eligible patients were required to have two or more RA diagnoses from physician visits that were between 7 and 365 days apart, a baseline period of 6 months with continuous enrollment with medical and pharmacy benefits, and have results for at least one of the three lab tests occurring either during baseline or follow-up. Labs of interest included erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and low density lipoprotein cholesterol (LDL-C) and were available for a subset of RA patients from electronic records of tests performed by a national laboratory chain ordered during routine clinical care. We identified the first hospitalized MI event by inpatient primary ICD9 diagnosis codes ‘41001′, ‘41011’, ‘41021’, ‘41031’, ‘41041’, ‘41051’, ‘41061’, ‘41071’, ‘41081’, or ‘41091’ with at least a 3 day length of stay (or expired as the discharge status of the hospitalization). We examined the association between ESR, CRP and LDL-C quartiles (to avoid assumptions of linearity) and hospitalized MI, controlling for age and sex; and stratified by sex, controlling for age, using proportional hazard regression to estimate hazard ratios (HRs).
Results: We identified 116,181 RA patients, 74.8% of whom were women. Mean age was 48.2 ± 15.2 SD years and 74.8% were female. Depending on lab tests of interest, the numbers patients who had MI during follow-up ranged from 85 to 110 (table). The overall and sex-specific crude incidence rates of MI were 2.7 cases per 1,000 person-years, 2.1 among women, and 4.8 among men. After controlling for age and sex, higher CRP (highest compared to the lowest CRP quartile) was associated with a 3.0 (95% CI: 1.5-5.9) and higher ESR (highest compared to the lowest quartile of ESR) had an HR = 2.5 (95% CI: 1.5-4.3) for MI, but higher LDL-C was not significantly associated with increased MI risk (table). The observed association between CRP and MI appeared greater for women.
Conclusion: Among this large national sample of RA patients, inflammatory markers (both CRP and ESR) were significantly associated with increased MI risk but LDL-C was not.
Table Hazard Ratios (95% CI) for Factors Associated with Myocardial Infarction
|
|
Overalla |
Menb |
Womenb |
||||||
|
C-Reactive Protein quartile (mg/dL) |
|
|
|
|
|
|
|
|
|
|
Events, N |
85 |
42 |
43 |
||||||
|
1st (<=1.2) [referent] |
1.00 |
|
1.00 |
|
|
1.00 |
|
|
|
|
2nd (>1.2 and <=3.1) |
1.09 |
(0.48 |
2.48) |
0.88 |
(0.32 |
2.44) |
1.64 |
(0.39 |
6.89) |
|
3rd (>3.1 and <=8.1) |
2.56 |
(1.28 |
5.15) |
2.02 |
(0.85 |
4.82) |
4.06 |
(1.16 |
14.19) |
|
4th (>8.1) |
2.97 |
(1.49 |
5.93) |
1.51 |
(0.61 |
3.77) |
6.76 |
(2.00 |
22.89) |
|
Erythrocyte sedimentation rate quartile (mm/hr) |
|
|
|
|
|
|
|
|
|
|
Events, N |
95 |
40 |
55 |
||||||
|
1st (<=4) [referent] |
1.00 |
|
|
1.00 |
|
|
1.00 |
|
|
|
2nd (>4 and <=9) |
0.85 |
(0.40 |
1.77) |
0.95 |
(0.34 |
2.72) |
0.81 |
(0.29 |
2.27) |
|
3rd (>9 and <=20) |
1.52 |
(0.81 |
2.83) |
2.00 |
(0.82 |
4.88) |
1.30 |
(0.55 |
3.11) |
|
4th (>20) |
2.52 |
(1.46 |
4.34) |
2.77 |
(1.24 |
6.19) |
2.40 |
(1.12 |
5.11) |
|
Low density lipoprotein cholesterol quartile (mg/dL) |
|
|
|
|
|
|
|
|
|
|
Events, N |
110 |
59 |
51 |
||||||
|
1st (<=83) [referent] |
1.00 |
|
|
1.00 |
|
|
1.00 |
|
|
|
2nd (>83 and <=105) |
1.09 |
(0.66 |
1.81) |
0.97 |
(0.50 |
1.90) |
1.29 |
(0.59 |
2.86) |
|
3rd (>105 and <=130) |
0.81 |
(0.46 |
1.40) |
0.72 |
(0.34 |
1.52) |
0.94 |
(0.40 |
2.18) |
|
4th (>130) |
1.03 |
(0.60 |
1.78) |
0.97 |
(0.46 |
2.04) |
1.15 |
(0.50 |
2.64) |
a. Adjusting for age and gender; b. Adjusting for age.
Disclosure:
J. Zhang,
None;
L. Chen,
None;
E. S. Delzell,
Amgen,
2;
P. M. Muntner,
Amgen ,
2,
Amgen,
5;
W. B. Hillegass,
None;
M. M. Safford,
None;
I. E. Navarro,
None;
J. R. Curtis,
Roche/Genetech, UCB, Centocor, CORRONA, Amgen Pfizer, BMS, Crescendo, Abbott,
5,
Roche/Genetech, UCB, Centocor, CORRONA, Amgen Pfizer, BMS, Crescendo, Abbott,
2.
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