Abstract：
OBJECTIVE: Atrial fibrillation (AF) is a potentially lethal complication that leads to increased hospitalization, disability and mortality. Furthermore, the risk of cardiovascular disease is increased in RA. We evaluated whether DMARD treatment is associated with incident AF in patients with seropositive RA (SPRA).
METHODS: The South Korean Health Insurance Review and Assessment Service database was used to identify patients newly diagnosed with SPRA between 2010 and 2020. A nested case-control analysis was performed to match AF-affected patients to unaffected controls for age, sex, follow-up duration, and index year of SPRA diagnosis at a 1:4 ratio. Adjusted conditional logistic regression was used to identify the predictive factors for AF.
RESULTS: Of the 108 085 patients with SPRA, 2,629 (2.4%) developed new-onset AF, and the proportion of females was ∼67%. In the matched population, pre-existing comorbidities of hypertension, chronic kidney disease, and heart failure were associated with increased risk of AF. Meanwhile, the use of methotrexate (MTX) decreased the risk of incident AF [adjusted odds ratio (aOR), 0.89], whereas the use of leflunomide (LEF) increased AF (aOR, 1.21). In a subgroup of patients aged ≥50 years, LEF and adalimumab increased the occurrence of AF, while MTX decreased AF in males and LEF increased this risk in females.
CONCLUSIONS: Although the number of subjects developing new-onset AF was small, MTX decreased and LEF increased incident AF in patients with RA. Especially, a distinct pattern of AF risk with DMARDs usage was observed according to age and sex.
METHODS: The South Korean Health Insurance Review and Assessment Service database was used to identify patients newly diagnosed with SPRA between 2010 and 2020. A nested case-control analysis was performed to match AF-affected patients to unaffected controls for age, sex, follow-up duration, and index year of SPRA diagnosis at a 1:4 ratio. Adjusted conditional logistic regression was used to identify the predictive factors for AF.
RESULTS: Of the 108 085 patients with SPRA, 2,629 (2.4%) developed new-onset AF, and the proportion of females was ∼67%. In the matched population, pre-existing comorbidities of hypertension, chronic kidney disease, and heart failure were associated with increased risk of AF. Meanwhile, the use of methotrexate (MTX) decreased the risk of incident AF [adjusted odds ratio (aOR), 0.89], whereas the use of leflunomide (LEF) increased AF (aOR, 1.21). In a subgroup of patients aged ≥50 years, LEF and adalimumab increased the occurrence of AF, while MTX decreased AF in males and LEF increased this risk in females.
CONCLUSIONS: Although the number of subjects developing new-onset AF was small, MTX decreased and LEF increased incident AF in patients with RA. Especially, a distinct pattern of AF risk with DMARDs usage was observed according to age and sex.
摘要：
目的：心房颤动（AF）是一种潜在的致命性并发症，可导致住院时间增加，残疾和死亡率。此外，RA患者患心血管疾病的风险增加.我们评估了DMARD治疗是否与血清阳性RA（SPRA）患者的房颤相关。
方法：使用韩国健康保险审查和评估服务数据库来识别2010年至2020年间新诊断为SPRA的患者。进行巢式病例对照分析，以将受房颤影响的患者与未受影响的对照组进行年龄匹配。性别,随访持续时间,SPRA诊断的指标年为1:4。使用调整后的条件逻辑回归来确定AF的预测因素。
结果：在108085例SPRA患者中，2,629（2.4％）出现新发房颤，女性比例为67%。在匹配的人群中，预先存在的高血压合并症，慢性肾病,心力衰竭与房颤风险增加相关。同时,甲氨蝶呤（MTX）的使用降低了房颤事件的风险[校正比值比（aOR），0.89],而使用来氟米特（LEF）增加了AF（aOR，1.21).在年龄≥50岁的患者亚组中，LEF和阿达木单抗增加了房颤的发生率，而MTX降低了男性的房颤，而LEF增加了女性的这种风险。
结论：尽管发生新发房颤的受试者数量很少，RA患者的MTX降低，LEF增加了房颤事件。尤其是,根据年龄和性别,观察到使用DMARDs的房颤风险的不同模式.
方法：使用韩国健康保险审查和评估服务数据库来识别2010年至2020年间新诊断为SPRA的患者。进行巢式病例对照分析，以将受房颤影响的患者与未受影响的对照组进行年龄匹配。性别,随访持续时间,SPRA诊断的指标年为1:4。使用调整后的条件逻辑回归来确定AF的预测因素。
结果：在108085例SPRA患者中，2,629（2.4％）出现新发房颤，女性比例为67%。在匹配的人群中，预先存在的高血压合并症，慢性肾病,心力衰竭与房颤风险增加相关。同时,甲氨蝶呤（MTX）的使用降低了房颤事件的风险[校正比值比（aOR），0.89],而使用来氟米特（LEF）增加了AF（aOR，1.21).在年龄≥50岁的患者亚组中，LEF和阿达木单抗增加了房颤的发生率，而MTX降低了男性的房颤，而LEF增加了女性的这种风险。
结论：尽管发生新发房颤的受试者数量很少，RA患者的MTX降低，LEF增加了房颤事件。尤其是,根据年龄和性别,观察到使用DMARDs的房颤风险的不同模式.
