Cardiovascular, rheumatologic, and pharmacologic predictors of stroke in patients with rheumatoid arthritis: A nested, case-control study

Zurab Nadareishvili, Kaleb Michaud, John M. Hallenbeck, Frederick Wolfe

Research output: Contribution to journalArticle

Abstract

Objective. To determine the risk of stroke in patients with rheumatoid arthritis (RA) and risk factors associated with stroke. Methods. We performed nested case-control analyses within a longitudinal databank, matching up to 20 controls for age, sex, and time of cohort entry to each patient with stroke. Conditional logistic regression was performed as an estimate of the relative risk of stroke in RA patients compared with those with noninflammatory rheumatic disorders, and to examine severity and anti-tumor necrosis factor (anti-TNF) treatment effects in RA. Results. We identified 269 patients with first-ever all-category strokes and 67 with ischemic stroke, including 41 in RA patients. The odds ratio (OR) for the risk of all-category stroke in RA was 1.64 (95% confidence interval [95% CI] 1.16-2.30, P = 0.005), and for ischemic stroke was 2.66 (95% CI 1.24-5.70, P = 0.012). Ischemic stroke was predicted by hypertension, myocardial infarction, low-dose aspirin, comorbidity score, Health Assessment Questionnaire score, and presence of total joint replacement, but not by diabetes, smoking, exercise, or body mass index. Adjusted for cardiovascular and RA risk factors, ischemic stroke was associated with rofecoxib (P = 0.060, OR 2.27 [95% CI 0.97-5.28]), and possibly with corticosteroid use. Anti-TNF therapy was not associated with ischemic stroke (P = 0.584, OR 0.80 [95% CI 0.34-1.82]). Conclusion. RA is associated with increased risk of stroke, particularly ischemic stroke. Stroke is predicted by RA severity, certain cardiovascular risk factors, and comorbidity. Except for rofecoxib, RA treatment does not appear to be associated with stroke, although the effect of corticosteroids remains uncertain.

Original languageEnglish (US)
Pages (from-to)1090-1096
Number of pages7
JournalArthritis Care and Research
Volume59
Issue number8
DOIs
StatePublished - Aug 15 2008
Externally publishedYes

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Case-Control Studies
Rheumatoid Arthritis
Stroke
Confidence Intervals
Odds Ratio
Comorbidity
Adrenal Cortex Hormones
Replacement Arthroplasties
Rheumatoid Factor
Aspirin
Body Mass Index
Therapeutics
Tumor Necrosis Factor-alpha
Logistic Models
Smoking
Myocardial Infarction
Databases
Exercise
Hypertension

ASJC Scopus subject areas

  • Rheumatology

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Cardiovascular, rheumatologic, and pharmacologic predictors of stroke in patients with rheumatoid arthritis : A nested, case-control study. / Nadareishvili, Zurab; Michaud, Kaleb; Hallenbeck, John M.; Wolfe, Frederick.

In: Arthritis Care and Research, Vol. 59, No. 8, 15.08.2008, p. 1090-1096.

Research output: Contribution to journalArticle

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abstract = "Objective. To determine the risk of stroke in patients with rheumatoid arthritis (RA) and risk factors associated with stroke. Methods. We performed nested case-control analyses within a longitudinal databank, matching up to 20 controls for age, sex, and time of cohort entry to each patient with stroke. Conditional logistic regression was performed as an estimate of the relative risk of stroke in RA patients compared with those with noninflammatory rheumatic disorders, and to examine severity and anti-tumor necrosis factor (anti-TNF) treatment effects in RA. Results. We identified 269 patients with first-ever all-category strokes and 67 with ischemic stroke, including 41 in RA patients. The odds ratio (OR) for the risk of all-category stroke in RA was 1.64 (95{\%} confidence interval [95{\%} CI] 1.16-2.30, P = 0.005), and for ischemic stroke was 2.66 (95{\%} CI 1.24-5.70, P = 0.012). Ischemic stroke was predicted by hypertension, myocardial infarction, low-dose aspirin, comorbidity score, Health Assessment Questionnaire score, and presence of total joint replacement, but not by diabetes, smoking, exercise, or body mass index. Adjusted for cardiovascular and RA risk factors, ischemic stroke was associated with rofecoxib (P = 0.060, OR 2.27 [95{\%} CI 0.97-5.28]), and possibly with corticosteroid use. Anti-TNF therapy was not associated with ischemic stroke (P = 0.584, OR 0.80 [95{\%} CI 0.34-1.82]). Conclusion. RA is associated with increased risk of stroke, particularly ischemic stroke. Stroke is predicted by RA severity, certain cardiovascular risk factors, and comorbidity. Except for rofecoxib, RA treatment does not appear to be associated with stroke, although the effect of corticosteroids remains uncertain.",
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