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- Stamatis, Pavlos, et al.
(author)
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Coronary Artery Disease in a Population-Based Cohort of Biopsy-Proven Giant Cell Arteritis in Southern Sweden
- 2019
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In: Arthritis & Rheumatology. - : Wiley. - 2326-5205 .- 2326-5191. ; 71:Suppl 10
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Conference paper (other academic/artistic)abstract
- Background/Purpose: The aim of this study was to estimate the incidence rate and prevalence of coronary artery diseases (CAD) in patients with temporal artery positive giant cell arteritis (TAB+GCA) from a defined population in southern Sweden, and to describe characteristics of CAD in this sample.Methods: The study cohort consisted of 1202 patients (71.9% women) diagnosed with TAB+GCA between 1997 and 2016. Patients were identified from the database of the Department of Pathology which covers all the hospitals in the Skåne region of Sweden. The cohort was linked to the registry for acute coronary care (SWEDEHEART) which provides nationwide coverage since 1995. All the GCA patients with symptoms suggesting acute coronary syndrome who had been admitted to a coronary care unit (CCU) were identified. CAD was defined as an admission to a CCU for ST-Elevation Myocardial Infarction (STEMI), Non-ST-Elevation Myocardial Infarction (NSTEMI), stable angina, or unstable angina. For incidence rate analyses, the person-years of follow-up was calculated from GCA diagnosis until first CAD, death or December 31, 2016, whichever came first.Results: 126 of 1202 GCA patients had suffered at least one acute coronary event (Table 1) yielding the cumulative incidence of 10.5% (95% CI 8.7-12.3). Of the 126 patients with CAD, 44 (34.9%) were diagnosed with CAD before their GCA diagnosis, 11 (8.7%) both before and after their diagnosis, and 71 (56.3%) solely after their GCA diagnosis. The total number of CCU admissions of all the 126 GCA CAD+ patients was 209: 101 admissions (48.3%) for NSTEMI, 55 (26.3%) for stable angina, 29 (13.9%) for STEMI, and 24 (11.5%) for unstable angina. Eighty-two GCA patients (61% women) developed CAD after their diagnosis of GCA. During a total follow-up time of 8047 person-years, the incidence rate of CAD in patients with TAB+GCA was 1.0 per 100 person-years (95% CI 0.8-1.2) for all patients, 0.8 (95% CI 0.6-1.1) for women and 1.6 (95% CI 1.1-2.2) for men, p=0.02. Fifteen GCA patients suffered from a CAD event in 1156 person-years during the first year after the GCA diagnosis, resulting in an incidence rate of 1.3 per 100 person-years (95% CI 0.6-2.0). 703/1202 (58.5%) GCA patients were alive on December 31, 2016, of which 72 patients had at least one previous CAD event yielding a prevalence of CAD in GCA of 10.2%.Conclusion: The incidence of CAD in GCA is comparable to what has been previously found in the Swedish background population. The incidence rate is higher among men compared to women. Coronary artery disease affects every tenth patient with TAB+GCA in this cohort. Further studies are needed to explore the impact of CAD on clinical outcomes in patients with GCA.
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- Lindegren, Camilla, et al.
(author)
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Intake of Dairy Products as a Risk Factor for Rheumatoid Arthritis; A Nested Case-Control Study
- 2022
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In: Arthritis & Rheumatology. - 2326-5205. ; 74:Suppl. 9
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Conference paper (other academic/artistic)abstract
- Background/Purpose: There has been increasing interest in diet as a factor that may contribute to the development of rheumatoid arthritis (RA). There is limited and somewhat contradictory information on the impact of dairy products in this context. The purpose of this study was to investigate the relation between intake of various dairy products and the risk of RA in a nested case-control study.Methods: Participants in a population-based survey conducted in 1991-1996 who were subsequently diagnosed with RA (from inclusion until December 2016) were identified through register linkage and validated in a structured review of case records. Four controls for each validated case, matched for sex, year of birth, and year of inclusion, were selected from the study cohort. The controls were alive and free of RA when the index person was diagnosed with RA. At inclusion in the survey, diet was assessed using a modified diet history method, consisting of a seven-day food record, a food questionnaire, and a structured interview. Reported intakes of dairy products were divided into groups based on quartiles, with the lowest quartile set as the reference in all analyses. Based on conditional logistical regression, including adjustments for total energy intake and for potential confounders that have been associated with diet and RA (i.e. current smoking, physical activity and alcohol intake), odds ratios (ORs) for RA were estimated, with 95% confidence intervals (CI). Potential misreporters of total energy intake were excluded. Assessed types of dairy products included regular (non-fermented) milk, fermented milk, cream, cheese, and butter.Results: There were 305 incident cases of RA (76 % females, 67 % anti-citrullinated protein antibody and/or rheumatoid factor positive, mean age 68.9 years at onset and mean duration of 12 years from screening to RA diagnosis). The group with highest intake of regular milk ( >398 g/day) had a significantly increased risk of RA (multi-adjusted OR 1.86; 95% CI 1.08-3.22). High intake of cheese with >11% fat ( >56 g/day) was inversely associated with risk of RA (adjusted OR 0.53; 95% CI 0.31-0.92) and a trend of lower risk across quartiles of cheese intake was observed. Intake of cream, fermented milk or butter did not have a significant impact on the risk of developing RA. Associations for intakes of cheese and regular milk with the risk of RA remained significant in multivariable analysis, including both exposures (Table 1).Conclusion: High intake of regular milk appears to increase the risk of RA, whereas high intake of cheese may reduce the risk. Potential explanations for these patterns include differential effects of dairy product depending on the extent of processing and fermentation, that may affect the gut microbiota and modulate the risk of developing RA.
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- Rydell, Emil, et al.
(author)
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High Disease Activity over Time and Persistent Inflammation Are Associated with Increased Risk of Cardiovascular Disease in Patients with Early Rheumatoid Arthritis
- 2015
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In: Arthritis & Rheumatology. - 2326-5205. ; 67:Suppl. 10
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Conference paper (other academic/artistic)abstract
- Background/Purpose:Rheumatoid arthritis (RA) is associated with an increased rate of cardiovascular (CV) disease. Systemic inflammation has been implicated as a key factor behind CV comorbidity in RA. The objective of this study was to investigate the impact of disease activity and inflammation over the first two years on the risk of subsequent CV events in patients with early RA.Methods:An inception cohort of patients with early RA (symptom duration Results:A total of 207 patients with early RA (70 % women, mean age 62 years) were followed from the 24-month visit to the first CV event, migration from the region, death or Dec 31, 2011. CV events occurred in 54 patients during the follow-up. A high disease activity over the first two years (defined as AUC for DAS28 above the median) was associated with a significantly increased risk of CV events (age-sex adjusted hazard ratio (HR) 2.03; 95 % confidence interval (CI) 1.15-3.60). In separate analyses, it was demonstrated that patients with CRP at two years within the highest quartile (>11 mg/l) had a significantly higher risk of CV events compared to those with lower CRP values (age-sex adjusted HR 1.82; 95 % CI 1.04-3.17). Results were similar in models adjusted for smoking, hypertension and diabetes in addition to age and sex (multivariate adjusted HRs for DAS28-AUC above the median: 2.05 (95% CI 1.13-3.73); for CRP>11 mg/l: 1.90 (95% CI 1.06-3.42)).Conclusion:A high disease activity during the first two years after RA diagnosis and a high CRP at the two-year follow-up were both associated with a doubled risk of CV events. These findings suggest that patients with persistently active RA are at particularly increased risk, and highlight the importance of disease control for CV prevention in patients with early RA.
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