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RA characteristics responsible for roughly 30% of CVD events
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In patients with rheumatoid arthritis who experienced CVD events, roughly 30% of these events can be ascribed to characteristics of rheumatoid arthritis, according to findings.
Researchers combined 13 cohorts of patients with rheumatoid arthritis (RA) from 10 countries into a large, international patient cohort (n=5,638; mean age, 55.3 years; 76% women). Patients had a physician diagnosis of RA and/or met either 1987 or 2010 ACR criteria for RA, and had no prior cardiovascular disease (CVD). Cohorts were prospectively studied through regular study visits and were retrospectively followed through medical record review. Baseline data collected included traditional CVD risk factors, as well as several RA-specific characteristics.
The researchers estimated the effects of CVD risk factors and RA factors on the development of CVD.
During a mean follow-up of 5.8 ±4.4 years, CVDs occurred in 389 patients. These cases consisted of the following events: myocardial infarction, 166 patients; unstable/stable angina, 88 patients; revascularization, 62 patients; cardiovascular deaths, 35 patients; cerebrovascular events, 147; and peripheral vascular events, 46.
Ten years after baseline, the adjusted cumulative incidence of CVD was 20.9% among men and 11.1% among women. Minimal differences were observed in 10-year CVD risk after adjustment for CVD risk factors. After adjustment for age, the relative risk of CVD was higher among men vs. women (HR: 1.74). A significant overall association was seen between age and CVD in both genders, and this effect persisted after adjustment for other CVD risk factors.
Researchers also evaluated population attributable risk (PAR), which is an estimate of the proportion of CVD events that could be prevented by a possible target intervention. Of the traditional CVD risk factors, smoking and hypertension had the highest overall PAR in both genders. Men had nearly twice the PAR for smoking and hypertension vs. women. Total cholesterol had an 11.5% PAR overall, with women having an insignificantly higher PAR vs. men.
Of the CVD events that occurred, roughly 70% were due to CVD risk factors and RA characteristics combined. Specifically, 49% were due to CVD risk factors and 30% were attributable to RA characteristics.
“Optimal management of CVD risk factors continues to be an important goal of CVD risk management in patients with RA, as evidenced by the sizeable proportion of CVD risk attributable to CVD risk factors,” the researchers wrote. “Furthermore, the substantial proportion of CVD risk attributable to RA characteristics indicates that RA disease activity and severity play an important role in efforts to reduce CVD risk among patients with RA.”-By Jennifer Byrne
Disclosures: Please see the full study for a list of relevant disclosures.
--By Jennifer Byrne
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Ashira Blazer , MD
Much of the morbidity and mortality seen in patients with RA is due to CVD. In this large (5,638 patients), multicenter, international cohort study, the authors characterized the risk factors contributing to cumulative cardiovascular disease incidence. Endpoints included acute coronary syndromes (myocardial infarction and unstable angina), ischemic stroke, peripheral vascular disease and cardiovascular death. Beyond the age of 40 years, men displayed a higher incidence of CVD compared to women, with 20.9% of men and 11.1% of women reaching the primary end points respectively. The authors found that together known cardiovascular risk factors accounted for 70% of the cumulative incidence of CVD in this RA cohort. Of this, RA-related risk factors, including tender and swollen joint counts (as measured by the DAS-28), and RF/CCP serologies accounted for 30% of cardiovascular risk. Interestingly, traditional risk factors, such as smoking and hypertension, were more contributory to cardiovascular risk in men, whereas RA-related factors and diabetes were more contributory in women.
In women whose baseline DAS28 was higher than 3.2, lowering the DAS28 below 3.2 reduced cumulative CVD risk by 16.9%. The single most important modifiable risk factor was smoking, particularly for men. It accounted for 37% of attributable risk in men and 18% in women.
This study underscores the importance of assessing traditional CVD risk factors in patients with RA, as well as maintaining disease control in the prevention of cardiac events. While the multicenter approach and large number of patients are a study strength, the study is limited by varied data collection strategies at each of the centers with some centers collecting data prospectively and others retrospectively. In addition, the cohort was 94% European white patients which limits its generalizability in more diverse patient populations.
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Crowson CS, et al. Ann Rheum Dis. 2017; doi:10.1136/annrheumdis-2017-211735.
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