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Research ArticleRheumatoid Arthritis

Primary Prevention of Myocardial Infarction in Rheumatoid Arthritis Using Aspirin: A Case-crossover Study and a Propensity Score–matched Cohort Study

Josefina Durán, Christine Peloquin, Yuqing Zhang and David T. Felson
The Journal of Rheumatology April 2017, 44 (4) 418-424; DOI: https://doi.org/10.3899/jrheum.160930
Josefina Durán
From the Rheumatology Department, Pontificia Universidad Católica de Chile School of Medicine, Santiago, Chile; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA; Arthritis Research UK Epidemiology Unit, University of Manchester; Manchester UK National Institute for Health Research Biomedical Research Unit, Manchester, UK.
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  • For correspondence: jgduran@uc.cl
Christine Peloquin
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Yuqing Zhang
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David T. Felson
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    Table 1A.

    Study participants’ characteristics: case-crossover analysis. All covariates are measured prior to the index date. Values are n (%) or mean ± SD unless otherwise specified.

    CharacteristicsValues
    Subjects, n270
    Age, yrs73.5 ± 7.4
    Female151 (55.9)
    BMI, continuous26.6 ± 4.8
    BMI, categorical
      Underweight12 (4.4)
      Normal65 (24.1)
      Overweight96 (35.6)
      Obese46 (17.0)
      Missing51 (18.9)
    Smoking
      Non-smoker102 (37.8)
      Ex-smoker105 (38.9)
      Current smoker56 (20.7)
      Missing7 (2.6)
    Alcohol
      Non-drinker68 (25.2)
      Ex-drinker11 (4.1)
      Current drinker168 (62.2)
      Missing23 (8.5)
    Diabetes45 (16.7)
    Dyslipidemia31 (11.5)
    Hypertension145 (53.7)
    Antihypertensives179 (66.3)
    Antiaggregants/anticoagulants26 (9.6)
    Glucocorticoids133 (49.3)
    Lipid-lowering drugs68 (25.2)
    Nitrates19 (7.0)
    NSAID151 (55.9)
    GP visits11 ± 17
    Hospital visits1 ± 1
    • BMI: body mass index (underweight ≤ 18.5, normal weight = 18.5–24.9, overweight = 25–29.9, obese = BMI of 30 or greater); NSAID: nonsteroidal antiinflammatory drugs; GP: general practitioner.

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    Table 1B.

    Study participants’ characteristics: propensity score–matched cohort study. All covariates are measured prior to the index date. Values are n (%) or mean ± SD unless otherwise specified.

    CharacteristicsASA InitiatorsASA Non-users
    Subjects, n918918
    Demographic characteristics
      Age, yrs71.5 ± 7.271.3 ± 7.2
      Female608 (66.2)601 (65.5)
      BMI26.9 ± 4.927.1 ± 4.9
      Alcohol
        Non-drinker237 (25.8)227 (24.7)
        Ex-drinker38 (4.1)40 (4.4)
        Current drinker643 (70.0)651 (70.9)
      Smoking
        Non-smoker445 (48.5)406 (44.2)
        Ex-smoker309 (33.7)322 (35.1)
        Current smoker164 (17.9)190 (20.7)
      RA duration6.7 ± 4.86.7 ± 4.7
    Comorbidities
      Angina40 (4.4)29 (3.2)
      Atrial fibrillation73 (8.0)67 (7.3)
      Diabetes128 (13.9)117 (12.7)
      Dyslipidemia119 (13.0)132 (14.4)
      Hypertension489 (53.3)512 (55.8)
    Cardiovascular disease drugs
      Antiaggregants/anticoagulants41 (4.5)46 (5.0)
      Antihypertensive drugs
        ACE inhibitors228 (24.8)261 (28.4)
        ARB101 (11.0)112 (12.2)
        β-blockers180 (19.6)180 (19.6)
        Calcium channel blockers222 (24.2)234 (25.5)
        Diuretics359 (39.1)379 (41.3)
      Lipid-lowering drugs239 (26.0)259 (28.2)
      Nitrates39 (4.2)33 (3.6)
    Antiinflammatory drugs
      NSAID510 (55.6)520 (56.6)
      Glucocorticoids322 (35.1)311 (33.9)
    Health service use variables
      GP visits9 ± 810 ± 11
      Hospital visits1 ± 11 ± 1
    • ASA: aspirin; BMI: body mass index (underweight ≤ 18.5, normal weight = 18.5–24.9, overweight = 25–29.9, obese = BMI of 30 or greater); RA: rheumatoid arthritis; ACE: angiotensin-converting enzyme; ARB: angiotensin receptor blocker; NSAID: nonsteroidal antiinflammatory drugs; GP: general practitioner.

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    Table 2.

    Frequency of potential time-varying confounders between hazard periods and control periods in the case crossover analysis. Values are n (%) unless otherwise specified.

    VariablesCase PeriodControl Period
    Subjects, n270270
    Antihypertensives168 (62.2)157 (58.1)
    Antiaggregants/anticoagulants24 (8.9)19 (7.0)
    Glucocorticoids105 (38.9)111 (41.1)
    Lipid-lowering drugs60 (22.2)62 (23.0)
    Nitrates14 (5.2)8 (3.0)
    NSAID119 (44.1)113 (41.9)
    • NSAID: nonsteroidal antiinflammatory drugs.

    • View popup
    Table 3.

    Study results from both study designs. Association of ASA with cardiovascular events in RA.

    Study DesignSubjects, nHazard PeriodControl PeriodCrude OR (95% CI; case-crossover)
    Crude HR (95% CI; PS-matched analysis)
    Adjusted OR (95% CI; case-crossover)
    Adjusted HR (95% CI; PS-matched analysis)
    Case-crossover: 7-day exposure270
      ASA users55442.37 (1.04–5.43)1.83* (0.71–4.71)
    Case-crossover: 2002–2012 time period, 7-day exposure219
      ASA users47382.29 (0.94–5.56)1.96* (0.69–5.55)
    Case-crossover: concomitant exposure with index date270
      ASA users52422.00 (0.94–4.27)1.52* (0.65–3.59)
    ASA UserASA Non-user
    PS-matched cohort1836
    MI cases, n4432
    Total followup time, PY35313668
    Mean followup time, yrs3.854.0
    Incidence rate, per 1000 PY12.468.72
    1.42 (0.90–2.24)1.39** (0.87–2.23)
    • ↵* Adjusted for atrial fibrillation, diabetes, dyslipidemia, hypertension, peripheral vascular disease, stroke, NSAID, glucocorticoids, statins, nitrates, antihypertensives, anticoagulants, and antiaggregants.

    • ↵** Adjusted RA duration, age, sex, body mass index, smoking, alcohol, angina, atrial fibrillation, diabetes, dyslipidemia, hypertension, angiotensin-converting enzyme inhibitors, antiaggregants/anticoagulants, angiotensin receptor II blockers, β-blockers, calcium channel blockers, diuretics, glucocorticoids, lipid-lowering drugs, nitrates, NSAID, general practitioner visits, hospitalizations. ASA: aspirin; RA: rheumatoid arthritis; PS: propensity score; PY: patient-years; NSAID: nonsteroidal antiinflammatory drugs.

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The Journal of Rheumatology
Vol. 44, Issue 4
1 Apr 2017
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Primary Prevention of Myocardial Infarction in Rheumatoid Arthritis Using Aspirin: A Case-crossover Study and a Propensity Score–matched Cohort Study
Josefina Durán, Christine Peloquin, Yuqing Zhang, David T. Felson
The Journal of Rheumatology Apr 2017, 44 (4) 418-424; DOI: 10.3899/jrheum.160930

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Primary Prevention of Myocardial Infarction in Rheumatoid Arthritis Using Aspirin: A Case-crossover Study and a Propensity Score–matched Cohort Study
Josefina Durán, Christine Peloquin, Yuqing Zhang, David T. Felson
The Journal of Rheumatology Apr 2017, 44 (4) 418-424; DOI: 10.3899/jrheum.160930
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Keywords

RHEUMATOID ARTHRITIS
ASPIRIN
PROPHYLAXIS
PRIMARY PREVENTION
MYOCARDIAL INFARCTION
CARDIOVASCULAR DISEASE

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Keywords

  • rheumatoid arthritis
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  • myocardial infarction
  • cardiovascular disease

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