The impact of cardiovascular and cerebrovascular disease on the risk of dementia in rheumatoid arthritis: A mediation analysis
Authors' conclusion
The risk of ADRD in RA appears to be increased mainly in the presence of CVD. CVD was not a significant mediator on the risk of ADRD in RA. There was a significant synergistic effect of RA and CVD on ADRD risk.
Study context
- Population
- Patients >50 years with incident rheumatoid arthritis (RA) (1987 ACR criteria, 1980–2014) and matched comparators without RAmatched cohort
- Participants
- 1,754 patients
- Exposure
- RA vs comparators without RA
- RAn = 877
- Comparators without RAn = 877reference
- Outcome
- Role of CVD as a mediator between RA and ADRD
Methodological detailspopulation-based, matched 1:1 on age, sex and index year, Cox proportional hazard models, time dependent mediation analysis
- Population-based
- Matched 1:1 on age, sex and index year
- Cox proportional hazard models
- Time dependent mediation analysis
Main finding
As reported in the abstract
ADRD; CVD as time dependent mediator
RA
105
events
Comparators without RA
102
events
RA vs Comparators without RAAdjusted hazard ratio (95 % CI)
Without CVD as mediator; non-significant
1.27(0.96–1.69)
With CVD as time dependent mediator; non-significant
1.27(0.95,1.68)
- Mediation effect of any cardiovascular disease (CVD) on and related dementias (ADRD) risk not significant
- P = 0.84
Observational data: associations, not effects.
Further findings
Interaction between RA and CVD on ADRD risk
| aHR (95 % CI) | P value | ||
|---|---|---|---|
| RA × CVD interaction | 1.95 (1.11–3.42) | P = 0.021 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Events
| Outcome | RA | Comparators without RA |
|---|---|---|
| Developed CVD | 444 | 375 |
Original publication
The impact of cardiovascular and cerebrovascular disease on the risk of dementia in rheumatoid arthritis: A mediation analysis. Semin Arthritis Rheum. Published 11 October 2024. doi:10.
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