CARDIOVASCULAR MORBIDITY AND MORTALITY IN PATIENTS WITH SEROPOSITIVE RHEUMATOID-ARTHRITIS IN NORTHERN SWEDEN

Objective. To investigate the overall and the cardiovascular mortality in rheumatoid arthritis (RA) in Northern Sweden. To analyze the effec t of traditional risk factors and factors associated with rheumatoid d isease and its treatment on the progression of cardiovascular disease (CVD) and on mortality by all causes. Methods. A cohort of 606 patient s with seropositive RA were followed from 1979 to the end of 1994 or t o the death of the patient. Standardized mortality ratio and survival curves were estimated with the population of Vasterbotten as reference . Sex, age at disease onset? treatment with corticosteroids, use of di sease modifying antirheumatic drugs (DMARD) and hormone replacement th erapy (HRT), hypertension, diabetes mellitus, HLA types, and cause of death were recorded from disease onset. Cox's proportional hazards reg ression was used to identify important predictors for death and cardio vascular event during followup. Results. The standardized mortality ra tio in both sexes was significantly higher (1.57) for all underlying c auses together, for CVD (1.46) and for ischemic heart disease (IHD) (1 .54) compared to the reference population. The death rate increased ov er time. In multiple Cox regression analyses, male sex, higher age at disease onset, and former cardiovascular event increased the death rat e. Male sex, high age at disease onset, and hypertension increased the risk of cardiovascular event. Diabetes mellitus, treatment with corti costeroids, DMARD, or HRT did not influence the risks of death or firs t cardiovascular event. Conclusion. The overall mortality and death du e to CVD and IHD were in both sexes increased in seropositive RA. Male sex and high age at disease onset predicted death and cardiovascular event. Except for hypertension, which increased the risk for cardiovas cular event, neither of these traditional cardiovascular risk factors nor corticosteroid treatment influenced mortality by all causes or by cardiovascular event.