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Cardiovascular risk doubled in patients with RA vs the general population

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WASHINGTON — The risk for cardiovascular events in patients with rheumatoid arthritis was approximately double the risk observed in the general population, according to long-term findings presented at the American College of Rheumatology Annual Meeting.

Michael T. Nurmohamed, MD, of the Department of Rheumatology at the Amsterdam Rheumatology and Immunology Center, presented the 15-year findings.

Michael T. Nurmohamed

“This inception cohort started in 2001,” Nurmohamed said. “Nowadays, we know that the risk of cardiovascular disease is increased in RA, but the number of long-term follow-up studies is scarce.”

In the current study, researchers compared the risk of cardiovascular (CV) events in 353 patients with RA with those observed in 2,540 individuals in the general population and those observed in patients with type 2 diabetes. Researchers measured CV endpoints at baseline, 3 years, 10 years and 15 years. Incidence rates are reported in terms of 100 person-years.

Results showed 96 patients with RA developed a CV event during 2,703 person-years of follow-up. This was an incidence rate of 3.6 per 100 person-years. By comparison, in the general population, there were 298 individuals who developed a CV event, with 41 of those individuals having diabetes mellitus. The follow-up duration for this group was 25,335 person-years, for an incidence rate of 1.4 per 100 person-years.

In an analysis that adjusted for age and sex, results indicated CV events were increased in the RA group (hazard ratio [HR] = 2.14) and in the diabetes mellitus group (HR = 1.63) compared to individuals in the general population.

“The ongoing information in RA makes RA an independent cardiovascular risk factor,” Nurmohamed said. “This makes cardiovascular risk assessment as necessary in RA as in diabetes.”

In a further adjusted analysis that accounted for traditional CV risk factors, risk for CV events remained statistically significantly increased in patients with RA (HR = 1.73) and reached borderline significance in the diabetes arm (HR = 1.42). When prevalent CV disease was excluded, the risk in RA increased (HR = 2.16) while the risk in diabetes did not (HR = 1.28) as compared with the general population in the analysis that adjusted for traditional CV factors.  

“We need more and better implementation of programs for treating and screening cardiovascular risk factors in our practice,” Nurmohamed said. He noted effective treatment of RA may reduce CV events, and thus decrease mortality risk. However, the current strategy of tapering biologic therapies might cause increased CV risks.

“This should be addressed in future studies, and it also raises the question of whether we should consider making an RA-specific cardiovascular risk model,” he noted. – by Rob Volansky

Reference:

Agca R, et al. Abstract #1990. Presented at: The American College of Rheumatology Annual Meeting; Nov. 11-16, 2016. Washington.

Disclosure: Nurmohamed reports no relevant financial disclosures.