Antimalarial Adherence and Risk of Cardiovascular Events in Patients With Rheumatoid Arthritis and Systemic Lupus Erythematosus: A Population‐Based Study
Authors' conclusion
When people newly diagnosed with RA or SLE take their antimalarial regularly as prescribed (PDC ≥ 0.90), they have a 29% lower risk of sustaining a cardiovascular event than patients with a lower degree of adherence (PDC < 0.90) and a 28% lower risk than if they discontinue antimalarials.
Study context
- Population
- Patients with incident rheumatoid arthritis (RA)/systemic lupus erythematosus (SLE) and incident antimalarial use without prior cardiovascular event, British Columbia, Canada, January 1997–March 2015nine years mean follow-up
- Participants
- 16,538 patients
- Exposure
- Antimalarial adherence vs nonadherence vs discontinuation
- Outcome
- Incident cardiovascular events:
- Myocardial infarction (MI)
- Stroke
- Venous thromboembolism (VTE)
Methodological detailsmarginal structural models, administrative databases
- Marginal structural models
- Administrative databases
Main finding
As reported in the abstract
Incident cardiovascular events
Each group vs discontinuationAdjusted hazard ratio (95% CI)
Adherence
0.72(0.64–0.81)
Nonadherence
1.01(0.90–1.14)
- Incident cardiovascular events observed (overall)
- 2,174 (13.2%)
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | |
|---|---|---|
| All cardiovascular events, MI, stroke and VTE: adherence vs nonadherenceAdherencevs Nonadherence | aHR (all cardiovascular events) 0.71 (95% CI 0.61–0.82) | |
| All cardiovascular events, MI, stroke and VTE: adherence vs nonadherenceAdherencevs Nonadherence | aHR (MI) 0.62 (95% CI 0.51–0.75) | |
| All cardiovascular events, MI, stroke and VTE: adherence vs nonadherenceAdherencevs Nonadherence | aHR (stroke) 0.45 (95% CI 0.36–0.58) | |
| All cardiovascular events, MI, stroke and VTE: adherence vs nonadherenceAdherencevs Nonadherence | aHR (VTE) 0.65 (95% CI 0.46–0.93) | |
| 0.20.5125Ratio (log scale) |
Effect modification by older age
- Older age modified the association between antimalarial adherence and cardiovascular events
- P = 0.02
Original publication
Antimalarial Adherence and Risk of Cardiovascular Events in Patients With Rheumatoid Arthritis and Systemic Lupus Erythematosus: A Population‐Based Study. Arthritis Care Res (Hoboken). Published 18 December 2023. doi:10.
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