心脑血管疾病对类风湿关节炎患者痴呆症风险的影响：中介分析

IF 4.6 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism Pub Date : 2024-10-11 DOI:10.1016/j.semarthrit.2024.152570

Edward Lovering , Chanakya Kodishala , Roslin Jose George , Rakesh Kumar , Cynthia S Crowson , Ryan J Lennon , John M Davis III , Elena Myasoedova

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引用次数: 0

摘要

目的研究心血管疾病（CVD）在类风湿性关节炎（RA）与阿尔茨海默病及相关痴呆症（ADRD）之间的路径中作为介质的作用。在年龄、性别和指数年份方面，该队列与无RA的比较者进行了1:1匹配。心血管疾病事件的信息由人工从电子健康记录中提取。采用Cox比例危险模型研究了RA、心血管疾病和ADRD之间的关系。结果1754人被纳入研究（877名RA患者和877名未患RA的对比者）。在随访期间，105 名 RA 患者和 102 名非 RA 患者出现了 ADRD；444 名 RA 患者和 375 名非 RA 患者出现了心血管疾病。在没有（aHR 1.27，95 % CI 0.96，1.69）和有（aHR 1.27，95 % CI 0.95，1.68）心血管疾病作为时间依赖性中介的情况下，RA 与 ADRD 之间的关系均不显著。任何心血管疾病对 ADRD 风险的中介效应均不显著（p = 0.84）。我们发现 RA 和心血管疾病对 ADRD 风险有明显的交互作用（aHR 1.95，95 % CI 1.11，3.42；p = 0.021）。心血管疾病并不是RA患者ADRD风险的重要中介因素。RA和心血管疾病对ADRD风险有明显的协同作用。

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The impact of cardiovascular and cerebrovascular disease on the risk of dementia in rheumatoid arthritis: A mediation analysis

Objective

To examine the role of cardiovascular disease (CVD) as a mediator in the pathway between rheumatoid arthritis (RA) and Alzheimer's disease and related dementias (ADRD).

Methods

This retrospective population-based study included patients over 50 years of age with incident RA, who met the 1987 ACR criteria in 1980–2014. This cohort was matched 1:1 on age, sex and index year to comparators without RA. Information on CVD events was manually extracted from electronic health records. The relationships between RA, CVD and ADRD were examined using Cox proportional hazard models. Time dependent mediation analysis was used to examine the role of CVD as a mediator between RA and ADRD.

Results

1754 individuals were included (877 persons with RA and 877 comparators without RA). During follow-up, 105 patients with RA and 102 individuals without RA developed ADRD; 444 patients with RA and 375 individuals without RA developed CVD. There was a non-significant association between RA and ADRD both without (aHR 1.27, 95 % CI 0.96, 1.69) and with (aHR 1.27, 95 % CI 0.95,1.68) CVD as a time dependent mediator. The mediation effect of any CVD on ADRD risk was not significant (p = 0.84). We found a significant interaction between RA and CVD on the risk of ADRD (aHR 1.95, 95 % CI 1.11, 3.42; p = 0.021).

Conclusions

The risk of ADRD in RA appears to be increased mainly in the presence of CVD. CVD was not a significant mediator on the risk of ADRD in RA. There was a significant synergistic effect of RA and CVD on ADRD risk.

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来源期刊

Seminars in arthritis and rheumatism 医学-风湿病学

CiteScore

9.20

自引率

4.00%

发文量

176

审稿时长

46 days

期刊介绍： Seminars in Arthritis and Rheumatism provides access to the highest-quality clinical, therapeutic and translational research about arthritis, rheumatology and musculoskeletal disorders that affect the joints and connective tissue. Each bimonthly issue includes articles giving you the latest diagnostic criteria, consensus statements, systematic reviews and meta-analyses as well as clinical and translational research studies. Read this journal for the latest groundbreaking research and to gain insights from scientists and clinicians on the management and treatment of musculoskeletal and autoimmune rheumatologic diseases. The journal is of interest to rheumatologists, orthopedic surgeons, internal medicine physicians, immunologists and specialists in bone and mineral metabolism.