Statistical analysis was performed
with graphpad prism 5 (GraphPad Software Inc., La Jolla, CA, USA). Kaplan–Meier survival analysis was performed to identify time from RA diagnosis to first cardiovascular event and time from RA diagnosis to death. The denominator of all newly diagnosed RA patients within the 10-year study period, the vast majority seen as outpatients, was calculated from the Department of Rheumatology database. RA diagnosis was made using American College of Rheumatology (ACR) criteria and/or rheumatologist diagnosis. The rheumatology database case notes were also reviewed to selleck chemical confirm the presence or absence of a discharge diagnosis of ischemic heart disease to cross-check the accuracy and completeness of the ICD discharge coding search. Four hundred and six patients were discharged during the study period with combined
ICD9 or 10 codes for RA and a cardiovascular event. One hundred and ninety-four of these had a confirmed cardiovascular event, of whom 34 were diagnosed with RA between January 1999 and December 2008 prior to their cardiovascular event. This was the first cardiovascular event following RA diagnosis in all 34 patients. A search of the Rheumatology Departmental database yielded 619 additional patients who were diagnosed with RA during the study period (who did not sustain RG-7204 a cardiovascular event) giving a total of 653 patients (Fig. 1, flowchart of patient selection). The median RA disease duration of the cohort as a whole was 5.8 years (i.e., in over half of cohort, RA diagnosis was made post-March 2002). Of the 34 RA patients tetracosactide who had cardiovascular events, the median age was 64 years (range 47–79) and there was an equal sex distribution;
91% were rheumatoid factor positive; 59% of the cardiovascular events were non-ST elevation MI, 21% were ST elevation MI and 21% unstable angina. There were no cardiac arrests or deaths during the study period. The most common cardiovascular risk factors were smoking (41% current smokers, 35% ex-smokers) and hypertension (71%); 41% had a family history of ischemic heart disease and 12% had diabetes. Table 1 shows the use of rheumatoid and cardiovascular medications. None of the patients were on biologics at the time of their event. Reliable data on non-steroidal anti-inflammatory drug (NSAID) use was unavailable. The time to first cardiovascular event is shown in Figure 2. The probability of a cardiovascular event in the first year after diagnosis of RA was 0.64% and 9.4% after 10 years. The median time to first cardiovascular event from RA diagnosis was 2.53 years (range 0.02–8.31). In the whole cohort there were 26 documented deaths; cause of death could not be determined. Figure 3 shows the probability of death in the first year after RA diagnosis was 0.48% and at 10 years 8.16%. The median time to death for these 26 patients was 3.23 years (range 0.25–8.55).