Confounding by Indication Probably Distorts the Relationship between Steroid Use and Cardiovascular Disease in Rheumatoid Arthritis: Results from a Prospective Cohort Study

被引：45
作者：
van Sijl, Alper M. [1 ]
Boers, Maarten [1 ]
Voskuyl, Alexandre E. [1 ]
Nurmohamed, Michael T. [1 ]
机构：
[1] Vrije Univ Amsterdam, Med Ctr, Dept Rheumatol, Amsterdam, Netherlands
来源：
PLOS ONE | 2014年 / 9卷 / 01期
关键词：
GLUCOCORTICOIDS; RECOMMENDATIONS; MANAGEMENT; RISK;
D O I：
10.1371/journal.pone.0087965
中图分类号：
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号：
07 ; 0710 ; 09 ;
摘要：
Objective: To evaluate the risk of cardiovascular disease in patients with rheumatoid arthritis exposed to glucocorticoids. Methods: Retrospective analysis of exposure to glucocorticoids in a prospective cohort of 353 patients with rheumatoid arthritis followed from June 2001 up to November 2011 for incident cardiovascular disease in a hospital-based outpatient cohort in the Netherlands. Hazard ratios with 95%-confidence intervals were calculated for the association between different types of exposure to glucocorticoids and incident cardiovascular disease. Associations were adjusted for demographics, cardiovascular risk factors and disease related parameters. Results: Recent and current exposure to glucocorticoids were associated with incident cardiovascular disease, as was a longer duration of exposure and cumulative exposure to glucocorticoids. Adjustment for disease activity and severity negated the association. Conclusion: In observational studies the finding of incident cardiovascular disease in patients with rheumatoid arthritis exposed to glucocorticoids is strongly confounded by indication due to high disease activity. The adverse cardiovascular effects of glucocorticoids might be balanced by positive effects working through inflammation control.
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