Cardiovascular Morbidity and Mortality Among Working Individuals with Rheumatic Disease: Results from a Large Prospective Cohort Study

Background Cardiovascular comorbidities are common in rheumatic diseases and are associated with an increased mortality risk but have not been studied in a working population, with less severe disease. Also, the impact of premature cardiovascular mortality on work participation has been neglected until now.

Objectives The objectives of this study were to evaluate the cardiovascular risk in working individuals with inflammatory rheumatic diseases and to explore whether cardiovascular morbidity and mortality are associated with decreased work participation in this population.

Methods Employees from 45 companies in The Netherlands (n = 12,140) were prospectively followed up from 1998 onward by annual questionnaires. Data covering 10 years of follow-up was available (1998-2008) for rheumatic and cardiovascular morbidities. Self-reported rheumatic and cardiovascular diseases were verified by clinical review in hospital records in a subsample living in 1 specific region of The Netherlands. Information on the vital status was obtained by linking our records to national registries. Cox proportional hazards models were used to determine the contribution of cardiovascular comorbidity on mortality, with adjustment for confounders.

Results In the sample verified by clinical review, the 10-year risk of developing cardiovascular diseases tended to be increased in workers with inflammatory rheumatic diseases (n = 17) at baseline (relative risk, 2.30; 95% confidence interval [CI], 0.91-5.81) and was significantly increased in those with gout (n = 18) at baseline (relative risk, 3.64; 95% CI, 1.64-8.09) as compared with those without inflammatory rheumatic diseases or gout, respectively. Gout (n = 31; hazard ratio, 4.19; 95% CI, 1.33-13.25) and cardiovascular diseases (n = 206; hazard ratio, 2.19; 95% CI, 1.24-3.84) were significantly related to 10-year mortality. No deaths had occurred in individuals with inflammatory rheumatic diseases during follow-up.

Conclusions In this study, gout was significantly associated with cardiovascular comorbidity and mortality, but inflammatory rheumatic diseases were not. Decreased work participation in workers with gout and potentially inflammatory rheumatic diseases can be expected because of an increased morbidity but not mortality risk.