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Rheumatoid arthritis (RA) should be regarded as a high-risk factor for myocardial infarction (MI). Inflammatory cytokines (IL-1, IL-6, and TNF-α) released from arthritis could boost the immuno-inflammatory process, causing vulnerable plaque and prothrombotic status. Calcium channel blockers (CCBs) not only possess BP-lowering effect but also anti-inflammatory property. However, the association between CCBs and MI in RA remains unclear.
We investigated whether CCBs could decrease the incidence of MI in patients with RA.
We identified patients from the Registry for Catastrophic Illness, a nationwide database encompassing almost all of the RA patients in Taiwan from 1995 to 2008. The primary endpoint was MI and the median duration of follow-up was 3050 days. Propensity score matching and Cox proportional hazards regression models were used to estimate hazard ratios for MI.
Among 47,810 patients, 1,546 MI occurred during follow-up for an incidence of 3.5 person-years. Baseline characteristics were well-balanced after propensity matching. CCBs users have associated a 36% lower risk of MI (HR=0.637, 95% CI 0.549 to 0.740). The protective effect of CCBs therapy was significantly better in patients taking longer duration. The effect remained robust in subgroup analyses.
Therapy of CCBs is associated with a lower risk of MI among patients with RA. Hence, use of CCBs may be a compelling indication for patients with RA and hypertension.