Patients with radiographic axial spondyloarthritis (r-axSpA) are at increased risk of incident cardiovascular events. Tumor necrosis factor inhibitors (TNFi) have shown a protective effect against incident cardiovacular events. However, the incidence of recurrent cardiovascular events in patients with r-axSpA with a history of cardiovascular events, and the effect of TNFi on recurrent cardiovascular events remain unclear. We aimed to assess the incidence rate of recurrent cardiovascular events in patients with r-axSpA with a history of cardiovascular events and evaluate the effect of TNFi on the risk of recurrent cardiovascular events. This nationwide cohort study used data from the Korean National Claims Database. Data of patients with r-axSpA who had a history of cardiovascular events after being diagnosed with r-axSpA were extracted from the database. The outcome of interest was the recurrence of cardiovascular events (myocardial infarction or stroke). Patients were followed from the index date (date of the first cardiovascular event) to the date of cardiovascular event recurrence, the last date with claims data, or December 31, 2021, whichever occured first. The incidence rate of recurrent cardiovascular events was calculated. An inverse probability weighted Cox model was used to assess the effect of TNFi exposure on the risk of recurrent cardiovascular events. This study included 413 patients (TNFi non-exposure, n = 338; TNFi exposure, n = 75). The incidence rate of recurrent cardiovascular events was 32 (95% confidence interval [CI] 22–42) per 1,000 person-years (TNFi non-exposure, 36 [95% CI 24–48] per 1,000 person-years; TNFi exposure, 19 [95% CI 2–35] per 1,000 person-years). In the inverse probability weighted Cox model, TNFi exposure was significantly associated with a lower risk of recurrent cardiovascular events (hazard ratio 0.33, 95% CI 0.12–0.94). The incidence rate of recurrent cardiovascular events in patients with r-axSpA is substantial. TNFi exposure was associated with a lower risk of recurrent cardiovascular events.

中文翻译：

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放射学中轴​​型脊柱关节炎患者心血管事件复发率及肿瘤坏死因子抑制剂的作用


放射学中轴​​型脊柱关节炎 (r-axSpA) 患者发生心血管事件的风险增加。肿瘤坏死因子抑制剂（TNFi）已显示出对心血管事件的保护作用。然而，有心血管事件史的r-axSpA患者复发心血管事件的发生率以及TNFi对复发心血管事件的影响仍不清楚。我们的目的是评估有心血管事件史的 r-axSpA 患者复发心血管事件的发生率，并评估 TNFi 对复发心血管事件风险的影响。这项全国性队列研究使用了韩国国家索赔数据库的数据。从数据库中提取被诊断为 r-axSpA 后有心血管事件史的 r-axSpA 患者的数据。感兴趣的结果是心血管事件（心肌梗死或中风）的复发。对患者进行随访，从索引日期（首次心血管事件的日期）到心血管事件复发的日期、索赔数据的最后日期或 2021 年 12 月 31 日（以先发生者为准）。计算复发性心血管事件的发生率。使用逆概率加权 Cox 模型评估 TNFi 暴露对心血管事件复发风险的影响。这项研究包括 413 名患者（TNFi 未暴露，n = 338；TNFi 暴露，n = 75）。复发性心血管事件的发生率为每 1,000 人年 32 例（95% 置信区间 [CI] 22–42）（TNFi 未暴露，每 1,000 人年 36 例 [95% CI 24–48]；TNFi 暴露， 19 [95% CI 2-35] 每 1,000 人年）。 在逆概率加权 Cox 模型中，TNFi 暴露与心血管事件复发风险降低显着相关（风险比 0.33，95% CI 0.12-0.94）。 r-axSpA 患者的心血管事件复发率很高。 TNFi 暴露与心血管事件复发风险降低相关。