Change search
ReferencesLink to record
Permanent link

Direct link
The risk of acute coronary syndrome in rheumatoid arthritis in relation to tumour necrosis factor inhibitors and the risk in the general population: A national cohort study
Rheumatology, Division of Medicine, Department of Public Health and Clinical Medicine, University Hospital, SE-901 87 Umeå, Sweden; Department of Medicine, Clinical Epidemiology Unit, Karolinska Institute, SE-171 77 Stockholm, Sweden.
Department of Medicine, Clinical Epidemiology Unit, Karolinska Institute, SE-171 77 Stockholm, Sweden.
Rheumatology, Division of Medicine, Department of Public Health and Clinical Medicine, University Hospital, SE-901 87 Umeå, Sweden.
Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of of Gothenburg, Guldhedsgatan 10, SE-405 30 Gothenburg, Sweden.
Show others and affiliations
2014 (English)In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 16, no 3, R127- p.Article in journal (Refereed) Published
Abstract [en]

Introduction: The elevated risk of ischaemic heart disease in patients with rheumatoid arthritis (RA) has been linked to inflammation and disease severity. Treatment with tumour necrosis factor inhibitors (TNFis) is often effective in reducing disease activity and could possibly modify cardiovascular risk. Our objective in the study was to evaluate the risk of acute coronary syndrome (ACS) in patients with RA treated with TNFis compared with the risk among biologic-naïve RA patients and the general population.Methods: By linkage of the Swedish National Patient Register and the Swedish Biologics Register, we identified a cohort of patients who were started on their first biologic, a TNFi, between 2001 and 2010 (N = 7,704), and a cohort comprising matched biologic-naïve RA patient referents at a 3:1 ratio. Furthermore, a matched comparator cohort (5:1 ratio) was extracted from the Swedish population register. The incidence rates of a first ACS event were calculated and compared between cohorts using Cox proportional hazards regression in three different risk windows: ever-exposed, actively on TNFi and short-term exposure (active treatment maximized to 2 years). The models were adjusted for disease duration, joint surgery, comorbidity and socioeconomic factors, and, in a sensitivity analysis including a subpopulation started on therapy beginning 1 January 2006 or later, for dispensed drugs.Results: Based on 221 events in 7,704 patients (comprising 32,621 person-years) treated with TNFi biologics, the hazard ratio ((HR); ever-exposed) for ACS among the TNFi-exposed RA patients compared with biologic-naïve RA patients was 0.8 (95% confidence interval (CI) = 0.7 to 0.95). In comparison with the general population referents, statistical analysis using fully adjusted models resulted in a HR of 2.0 (95% CI = 1.8 to 2.3) for biologic-naïve RA patients and a HR of 1.6 (95% CI = 1.4 to 1.9) for the TNFi-exposed group. Similar risk estimates were obtained using the other two risk windows. A sensitivity analysis in which we compared the TNFi-exposed patients included from 1 January 2006 onward with biologic-naïve patients resulted in a HR (ever-exposed) of 0.7 (95% CI = 0.5 to 1.0).Conclusions: RA patients treated with TNFi had a lower risk of ACS compared with biologic-naïve RA patients. Compared with the general population, the risk among patients with RA was elevated, although the difference was less pronounced among the TNFi-exposed patients. This finding could be attributable to the TNFi as such, or it could correspond to a lower degree of inflammation in the TNFi-treated group. © 2014 Ljung et al.; licensee BioMed Central Ltd.

Place, publisher, year, edition, pages
BioMed Central , 2014. Vol. 16, no 3, R127- p.
National Category
Clinical Medicine
URN: urn:nbn:se:liu:diva-116380DOI: 10.1186/ar4584ISI: 000347078700022PubMedID: 24941916ScopusID: 2-s2.0-84904270084OAI: diva2:798846
Available from: 2015-03-27 Created: 2015-03-26 Last updated: 2015-09-02

Open Access in DiVA

fulltext(391 kB)58 downloads
File information
File name FULLTEXT01.pdfFile size 391 kBChecksum SHA-512
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMedScopus

Search in DiVA

By author/editor
Cöster, Lars
By organisation
Division of Inflammation MedicineFaculty of Health SciencesDepartment of Rheumatology
In the same journal
Arthritis Research & Therapy
Clinical Medicine

Search outside of DiVA

GoogleGoogle Scholar
Total: 58 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 87 hits
ReferencesLink to record
Permanent link

Direct link