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UBC Theses and Dissertations

Cardiovascular disease prevention in rheumatoid arthritis : three population-based studies in British Columbia Schmidt, Timothy Joseph


Background: Previous research suggest that individuals with Rheumatoid Arthritis (RA) may have an increased risk of Diabetes Mellitus (DM). Furthermore, RA individuals may receive sub-optimal care for their non-RA health related complications. Aims: 1) evaluate the risk of DM in RA compared to the general population; 2) evaluate quality of care for cardiovascular disease (CVD) prevention in RA by measuring compliance with general population screening guidelines. Methods: We conducted three studies using a population-based cohort of RA patients from 1996 to 2006, with follow-up until 2010, in British Columbia, identified using previously described criteria (N=36,438). Controls were selected from the general population and matched 1:1 to RA individuals on age, sex, and calendar year. Different inclusion and exclusion criteria were used in each study. Chapter 2 describes the risk of DM during follow-up in an incident RA cohort, and the risk associated with RA medications, using a Cox proportional hazard model. Chapter 3 and 4 describe the compliance with general population screening guidelines for DM and hyperlipidemia in RA compared to the general population, using predefined eligible periods. A generalized estimating equation model was used to compare RA compliance to controls. Results: Incidence of DM was 8.37 and 7.41 per 1,000P/Y in RA and controls, respectively. RA individuals had a 9% increase in the risk of developing DM compared to controls (aHR [95%CI]:1.09[1.02,1.18]). Glucocorticosteroid use was associated with a doubling in the risk of DM, while hydroxychloroquine and methotrexate use were associated with a reduction in the risk of DM. Compliance with the DM screening guideline was 71.4% and 70.6% in RA and controls, respectively. Compliance with the lipid screening guideline was 56% and 59% in RA and controls, respectively. RA individuals had a 5% greater odds of receiving a plasma glucose test and no difference in receiving a lipid test compared to controls. Conclusion: Risk of DM was higher in RA compared to controls, and screening for DM and hyperlipidemia in RA was similar to controls, but are still considered sub-optimal.

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