Aviña-Zubieta JA, Choi HK, Sadatsafavi M et al.
University of British Columbia and Arthritis Research Centre of Canada, BC, Canada.
Arthritis Rheum 2008;59:1690–7.
Editor’s note: Cardiovascular disease (CVD) is a key contributor to overall mortality in patients with rheumatoid arthritis (RA). In general terms, it is widely considered that the risk of CV death is increased two-fold in RA patients. Many studies have examined this issue and the present meta-analysis draws together these studies for the first time. The authors estimated the overall increased risk of CV death in RA from pooled data. They also investigated any time trend, and whether the quality and type of study made any difference to the results. Overall, the standardized mortality ratio (SMR) of CVD-related deaths in RA patients was 1.5 (95% confidence interval 1.39–1.61). There was significant heterogeneity amongst studies and, in general, mortality estimates were higher in clinic-based populations and non-inception cohort studies than in inception studies. Higher quality studies tended to show a lower estimate of CV mortality. The SMR was similar for men and women, and also similar in studies that enrolled participants prior to 1987 compared with those that enrolled after 1987. The SMR did not appear to be influenced by length of follow-up in the study. A subgroup analysis showed increased SMRs for both ischemic heart disease and cerebrovascular disease.