The American journal of medicine
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Mortality in rheumatoid arthritis is increased, about twice vs controls, and cardiovascular diseases are a major cause. The pathogenesis is primarily accelerated atherosclerosis of the coronary, cervical, and cerebral arteries, which is premature, pervasive, and progressive, but often occult, under-recognized, and under-treated. It is mostly driven by the chronic, systemic autoimmune inflammation, but increased prevalence of traditional risk factors and adverse effects of treatments are also very important. ⋯ Secondly, identifying and addressing the whole spectrum of traditional risk factors, currently often neglected, is necessary. Because long-term glucocorticoid exposure ≥5 mg/d may be associated with cardiovascular events and other harm, more intensive treatment, especially useful for bridging with methotrexate at the outset of treatment, needs to be limited in time and dosage. A multipronged approach may improve cardiovascular outcomes of RA patients in future studies.
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Intensive blood pressure lowering prevents major adverse cardiovascular events, but some patients experience serious adverse events. Examining benefit-harm profiles may be more informative than analyzing major adverse cardiovascular events and serious adverse events separately. ⋯ This post hoc proof-of-concept analysis demonstrates the utility of the outcome profile analysis that simultaneously examines the benefit and harm of the treatment.
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Observational Study
Outcomes of Oral Anticoagulation in Atrial Fibrillation Patients with or without Comorbid Vascular Disease: Insights from the GARFIELD-AF Registry.
Many patients with atrial fibrillation suffer from comorbid vascular disease. The comparative efficacy and safety of different types of oral anticoagulation (OAC) in this patient group have not been widely studied. ⋯ Atrial fibrillation patients with a history of vascular disease have worse long-term outcomes than those without. The association of NOACs vs VKA with clinical outcomes was more evident in atrial fibrillation patients with vascular disease.