Accelerated aging contributed to doubled risk for CVD among patients with rheumatoid arthritis

WASHINGTON — Patients with seropositive rheumatoid arthritis experienced accelerated aging, with an increasing effect on cardiovascular disease risk, according to research presented at the American College of Rheumatology Annual Meeting.

“We looked at accelerated aging and the risk of developing cardiovascular disease, and it turns out that in rheumatoid arthritis, the immune system ages prematurely; that’s one of the cardinal features of this disease,” researcher Eric L. Matteson, MD, MPH, chair of the division of rheumatology at Mayo Clinic in Rochester, Minn., told Healio.com.

Eric L. Matteson

“We know that people with rheumatoid arthritis … have a higher risk of cardiovascular disease,” Matteson said. “What we were interested in finding out is whether people who have rheumatoid arthritis also have accelerated cardiovascular disease, accelerated aging in the cardiovascular system. We think it’s because of a common mechanism of inflammation.”

Researchers studied a population-based cohort of 525 patients with rheumatoid arthritis (RA; mean age, 55 years; 71% women) without previous cardiovascular disease (CVD). Sixty eight percent were rheumatoid factor (RF) positive. Presence of CVD risk factors, including age, blood pressure, lipids, smoking, and diabetes mellitus at RA incidence, was confirmed through medical records, as was CVD (angina, heart failure, stroke and intermittent claudication) during follow-up. Researchers calculated 10-year Framingham risk scores (FRS), which included the effects of CVD risk factors, in patients with RA. They also determined whether RA disease characteristics, including RF positivity, acute phase reactants and extra-articular manifestations, modified CVD risk factor effects.

Eighty-four patients (47 women) developed CVD during a mean follow-up of 8.4 years, with FRS predicting 45.7 events (23.3 women). RF-positive patients experienced most of the excess events (37.2 of 38.3). Age had a greater effect on the risk for developing CVD among RF-positive patients, not RF-negative patients, and was nearly double the effect on the general population (P<.001), based on FRS estimates. This aging impact was negligible for patients aged younger than 50 years, but increased exponentially as CVD risk rose with age. CVD risk in patients aged older than 65 years with RF-positive RA was similar to that of persons aged older than 90 years in the general population. CVD risk in RF-positive RA patients also was influenced by acute phase reactants and severe extra-articular manifestations when considering the aging effect.

“Rheumatoid arthritis is related to inflammation, and cardiovascular disease is related to inflammation. We think this inflammatory process is associated with premature aging of the immune system and the cardiovascular system,” Matteson said. “ … people with rheumatoid arthritis have double the risk of developing heart disease than anybody else.”

Disclosure: Matteson and other researchers reported several financial disclosures.

For more information:

Crowson CS. P1248: Accelerated Aging Influences Cardiovascular Disease Risk in Rheumatoid Arthritis. Presented at: American College of Rheumatology 2012 Annual Meeting; Nov. 10-14, Washington.