Targeting Rheumatoid Arthritis "Touches" the Heart

Written on 10 October 2017. Posted in Rheumatology News & Perspectives

It is not a surprise to any clinician that rheumatoid arthritis (RA) contributes to the risk for cardiovascular (CV) events. Another perspective is however important: Do the traditional CV risk factors change their importance in the course of the RA disease. A recent meta-analysis showed that hypertension, diabetes, hypercholesterolemia and obesity increased the risk of cardiovascular disease in patients with RA. The impact of cardiovascular risk factors in RA patients, including potential gender-related differences and RA-specific variables has been evaluated across a broad international cohort.

Patients and methods

The present study was conducted in 13 rheumatology centers in 10 countries. Data on cardiovascular risk factors and RA characteristics were collected on a prospective basis for new patients or retrospectively through patient data. The primary endpoints were fatal and nonfatal cardiovascular events, including acute coronary syndrome, chronic ischemia, coronary revascularization, cardiovascular death, cerebrovascular events and peripheral vascular events. Traditional risk factors collected at baseline were age, sex, smoking status, systolic and diastolic blood pressure, lipid levels, BMI, family history of cardiovascular disease, diabetes, hypertension. Risk factors for RA collected at baseline were rheumatoid factor positivity, levels of ACPA (anti-citrullinated protein antibodies), erythrocyte sedimentation rate, C-reactive protein, disease activity evaluated using DAS28.

Results

Overall, 5,638 RA subjects with no history of cardiovascular disease were included (mean age 55.3 years ± 14.0 years, 76% were women). During the mean follow-up of 5.8 ± 4.4 years, 148 men and 241 women developed a cardiovascular event, i.e. an unadjusted cumulative incidence at 10 years post-inclusion, 20.9% and 11.1%, respectively. Risk factors included increased blood pressure, higher total cholesterol and high prevalence of smoking (p <0.001 for all). Among the traditional cardiovascular risk factors, smoking and hypertension were the most contributing factors to population-related risk as a whole and among both sexes, followed by cholesterol. In total, traditional cardiovascular risk factors accounted for about 1/3 of overall cardiovascular risk and 2/3 if associated with RA characteristics. The impact of RA on overall cardiovascular risk was higher in women (39.9%) than in men (18.0%), but with no significant difference (p = 0.39).

What to remember

Through the analysis of a large cohort of patients with RA, the results of this study show that 30% of cardiovascular events are attributable to RA. These data indicate that the activity of RA play an important role in reducing the risk of cardiovascular events in RA patients.

Tags: rheumatoid arthritis, CVD

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