Background/Purpose:

Cardiovascular diseases (CVDs) are a worldwide health problem, with an increased risk in Rheumatoid Arthritis (RA) due to its inflammatory context, comorbidities and the use of risk medications as corticosteroids or NSAIDs. The introduction of biological therapies and new therapeutic strategies have emerged in the last decades implying an important change in the management and evolution of RA, and also a greater awareness among rheumatologists about cardiovascular risk. However, the trend of CVDs in RA in Spain is unknown. Our objective was to analyze the incidence and trend of hospital admissions for CVDs in patients with RA in Spain during the period between 1999 and 2015.

Methods:

We performed an observational retrospective population study analyzing the spanish national administrative database that includes a Minimun Basic Data Set (MBDS) of hospital admissions of patients with RA during the period 1999 to 2015. We selected the MBDSs for CVDs, myocardial infarction (MI), ischemic heart disease (IHD), congestive heart failure (CHF), cerebrovascular disease (CeVD) and aortic aneurysm (AA). Cases were identified by the presence in primary and secondary diagnosis of ICD 9 codes. The population at risk was estimated through the population census of the National Institute of Statistics, with an estimated prevalence of RA of 0,5% (0,8% in women and 0,2% in men). Crude and adjusted rates of the selected CVDs were calculated, and the trend was analyzed using the Generalized Linear Model (GLM) with the year as the analysis variable. Statistical analysis was made using SPSS statistical package version 20 (SPSS Inc, Chicago, IL).

Results:

338.343 RA hospital admissions were detected in the period, being 207.597 (61,3%) due to CVDs. Table 1 summarizes the data of the six subgroups of CVDs along the seventeen  years period. Mean age was similar in all groups. Deaths during admission were greater in CHF and CeVD. AA group presented the lowest diabetes mellitus percentage. Age-adjusted rates during the period for all groups were greater in men than in women: Relative Risk (RR) around 2 in CVD, CHF and CeVD, around 5 in MI and IHD, and 12 in AA. An annual increase in all group rates was found with an estimation of 5-7% in CVD, MI, IHD, CHF and CeVD and 9% in AA.

Table 1. Trends data of cardiovascular diseases in spanish Rheumatoid Arthritis in-patients during 1999-2015 period. Age adjusted rates expressed as rate per 10⁵ inhabitants/year. SD standard deviation. CI 95% confidence interval 95%.

Conclusion:

CVDs were the first cause of hospital admissions in Spain in RA patients during the period 1999-2015. Moreover, in that period there was an increasing incidence of hospital admissions due to CVDs in all the studied subgroups, being strikingly higher in men after age-adjusted rates. An annual rate increase is estimated in all the different studied subgroups oscilating between 5 and 9% annual increasing.