Prevalence of ischemic heart disease and associated factors in patients with rheumatoid arthritis in Southern Brazil

Gomes, Rafael Kmiliauskis Santos; Albers, Ana Carolina; Salussoglia, Ana Isadora Pianowski; Bazzan, Ana Maria; Schreiner, Luana Cristina; Vieira, Mateus Oliveira; Silva, Patrícia Giovana da; Machado, Patrícia Helena; Silva, Cynthia Mara da; Mattos, Mauro Marcelo; Nobre, Moacyr Roberto Cuce

doi:10.1016/j.rbre.2017.01.006

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Original articles • Rev. Bras. Reumatol. 57 (5) • Sep-Oct 2017 • https://doi.org/10.1016/j.rbre.2017.01.006 copy

Prevalence of ischemic heart disease and associated factors in patients with rheumatoid arthritis in Southern Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To estimate the prevalence of ischemic heart disease and associated factors in patients with rheumatoid arthritis.

Methods:

A cross-sectional study using the American College of Rheumatology diagnostic criteria in order to select patients seen at primary or secondary health care units in Blumenau, Santa Catarina, Southern Brazil, in 2014. The presence of ischemic heart disease was defined as an acute myocardial infarction with percutaneous coronary intervention or coronary artery bypass graft surgery that has occurred after diagnosis. Fischer's exact test, Wald's linear trend test, and multivariate logistic regression analysis were used to test the associations.

Results:

Among 296 patients (83.1% female) with a mean age of 56.6 years and a mean rheumatoid arthritis duration of 11.3 years, 13 reported having acute myocardial infarction requiring a percutaneous or surgical reperfusion procedure, a prevalence of 4.4% (95% CI 2.0-6.7). Diabetes Mellitus (odds ratio [OR] 4.9 [95% CI 1.6-13.8]) and disease duration >10 years (OR 8.2 [95% CI 1.8-39.7]) were the only factors associated with an ischemic disease that remained in the final model, after the multivariate analysis.

Conclusion:

The prevalence of acute myocardial infarction was similar to that observed in other studies. Among the traditional risk factors, Diabetes Mellitus, and among the factors related to rheumatoid arthritis, disease duration, were the variables associated with comorbidity.

Keywords:
Rheumatoid arthritis; Cardiovascular disease; Acute myocardial infarction; Prevalence

Variables	Sample		Acute myocardial infarction		p-Value
	n	%	Prevalence (%)	CI 95%
Total	296	100.0	4.4	(2.0-6.7)

Gender (n = 296)					0.619^a a Fischer's exact test.
Male	50	16.9	4.0	(1.5-9.5)
Female	246	83.1	4.4	(1.8-7.0)

Age in years (n = 296)					0.400^a a Fischer's exact test.
20-59 (adults)	180	60.8	3.8	(1.0-6.7)
≥60 (elderly)	116	39.2	5.1	(1.1-9.2)

Hypertension (n = 296)					0.017^a a Fischer's exact test.
No	164	55.4	1.8	(0.2-3.8)
Yes	132	44.6	7.5	(3.0-12.5)

Diabetes Mellitus (n = 296)					0.010^a a Fischer's exact test.
No	262	88.5	3.0	(0.9-5.1)
Yes	34	11.5	14.7	(2.5-26.8)

Dyslipidemia (n = 296)					0.071^a a Fischer's exact test.
No	223	75.3	3.1	(0.8-5.4)
Yes	73	24.7	8.2	(1.8-14.5)

Body mass index (kg/m ² ) (n = 296)					0.364^b b Wald's linear trend test.
≤24.9	113	38.1	3.5	(0.8-6.9)
25-29.9	124	41.9	4.0	(0.5-7.5)
≥30	59	20	6.7	(0.1-13.2)

Smoking (n = 296)					0.053^a a Fischer's exact test.
Never smoked	167	56.4	2.3	(0.5-4.7)
Previous and/or current smokers	129	43.6	6.9	(2.5-11.4)

Physical leisure activity (n = 288)					0.214^a a Fischer's exact test.
Never practiced	114	39.6	3.4	(0.7-6.1)
Practiced and/or practices	174	60.4	6.1	(1.6-10.5)

Positive family history (n = 296)					0.136^a a Fischer's exact test.
No	169	57.1	2.9	(0.3-5.5)
Yes	127	42.9	6.2	(2.0-10.5)

Disease duration (n = 296)					0.001^a a Fischer's exact test.
0-10 years	175	59.1	1.1	(0.4-2.7)
≥11 years	121	40.9	9.0	(3.9-14.2)

Presence of rheumatoid factor (n = 266)					0.603^a a Fischer's exact test.
0-60 (negative, or low titers)	164	61.6	4.8	(1.5-8.2)
≥61 (high titers)	102	38.4	4.9	(0.6-9.1)

Variables	Gross analysis			Adjusted analysis
Total	OR	CI 95%	p-Value	OR	CI 95%	p-Value
Gender			0.882^a a Excluded from the multiple analysis (p > 0.20).			0.864
Male	1.0			1.0
Female	1.1	(0.2-5.2)		1.0	(0.4-2.3)

Age in years			0.600^a a Excluded from the multiple analysis (p > 0.20).			0.595
20-59 (adults)	1.0			1.0
≥60 (elderly)	1.3	(0.4-4.1)		1.3	(0.4-4.1)

Hypertension			0.027			0.116^b b Excluded from the final model (p > 0.05).
No	1.0			1.0
Yes	4.3	(1.1-16.3)		3.0	(0.7-12.4)

Diabetes Mellitus			0.005			0.006
No	1.0			1.0
Yes	5.4	(1.6-17.8)		3.5	(1.7-21.2)

Dyslipidemia			0.076			0.379^b b Excluded from the final model (p > 0.05).
No	1.0			1.0
Yes	2.7	(0.8-8.5)		1.7	(0.5-6.0)

Body mass index (kg/m ² )			0.367^a a Excluded from the multiple analysis (p > 0.20).			0.846
≤24.9	1.0			1.0
25-29.9	1.1	(0.2-4.3)		1.0	(0.2-3.6)
≥30	1.9	(0.4-8.2)		1.1	(0.2-5.4)

Smoking
Never smoked	1.0		0.068	1.0		0.108^b b Excluded from the final model (p > 0.05).
Previous and/or current smokers	3.5	(0.9-10.1)		2.7	(0.8-9.1)

Physical leisure activity			0.288^a a Excluded from the multiple analysis (p > 0.20).			0.399
Never practiced	1.0			1.0
Practiced and/or practices	1.8	(0.5-5.5)		1.6	(0.5-5.0)

Positive family history			0.175			0.221^b b Excluded from the final model (p > 0.05).
No	1.0			1.0
Yes	2.2	(0.7-6.9)		2.0	(0.6-6.5)

Disease duration			0.005			0.005
0-10 years	1.0			1.0
≥11 years	8.6	(1.8-39.7)		8.2	(1.9-43.6)

Presence of rheumatoid factor			0.993^a a Excluded from the multiple analysis (p > 0.20).			0.946
0-60 (negative, or low titers)	1.0			1.0
≥61 (high titers)	1.0	(0.3-3.1)		1.0	(0.2-3.2)

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E-mail: sbre@terra.com.br

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[1] *Corresponding author. Email: gomesmed2002@ibest.com.br (R.K. Gomes).