Cardiovascular disease risk profiles in inflammatory joint disease entities

Abstract

Background: Patients with inflammatory joint diseases (IJD) have increased risk of cardiovascular disease (CVD). Our aim was to compare CVD risk profiles in patients with IJD, including rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) and evaluate the future risk of CVD.

Methods: The prevalence and numbers of major CVD risk factors (CVD-RFs) (hypertension, elevated cholesterol, obesity, smoking, and diabetes mellitus) were estimated in patients with RA, axSpA and PsA. Relative and absolute risk of CVD according to Systematic Coronary Risk Evaluation (SCORE) was calculated.

Results: In total, 3791 patients were included. CVD was present in 274 patients (7.2%). Of those without established CVD; hypertension and elevated cholesterol were the most frequent CVD-RFs, occurring in 49.8% and 32.8% of patients. Patients with PsA were more often hypertensive and obese. Overall, 73.6% of patients had a minimum of one CVD-RF, which increased from 53.2% among patients aged 30 to <45 years, to 86.2% of patients aged 60 to ≤80 years. Most patients (93.5%) had low/moderate estimated risk of CVD according to SCORE. According to relative risk estimations, 35.2% and 24.7% of patients had two or three times risk or higher, respectively, compared to individuals with no CVD-RFs.

Conclusions: In this nationwide Norwegian project, we have shown for the first time that prevalence and numbers of CVD-RFs were relatively comparable across the three major IJD entities. Furthermore, estimated absolute CVD risk was low, but the relative risk of CVD was markedly high in patients with IJD. Our findings indicate the need for CVD risk assessment in all patients with IJD.

Keywords: Cardiovascular; Epidemiology; Rheumatoid arthritis; Spondyloarthritis; Spondyloarthropathies.

Fig. 1

Prevalence of hypertension, elevated total cholesterol (TC), obesity, current smoking and diabetes mellitus in patients with different inflammatory joint diseases and age strata (30 to <45 years, 45 to <60 years and 60 to ≤80 years), without established atherosclerotic cardiovascular disease (CVD). Hypertension was defined as the presence of self-reported hypertension, use of antihypertensive treatment and/or systolic BP/diastolic BP >140/90. Elevated TC was defined as TC >6.2 and/or use of lipid-lowering therapy. Body mass index >30 kg/m² was classified as obesity, whereas current smoking and diabetes mellitus was defined by the self-reported presence of these CVD risk factors

Fig. 2

Percentage of patients with rheumatoid arthritis, axial spondyloarthritis or psoriatic arthritis, aged 30 to <45 years, 45 to <60 years and 60 to <80 years with a minimum (min.) of 1, 2, 3, 4 and 5 out of 5 conventional cardiovascular risk factors

Fig. 3

Risk of cardiovascular disease according to the Systematic Coronary Risk Evaluation (SCORE) algorithm for countries with low risk of CVD, in patients with various inflammatory joint diseases, stratified by age (30 to <45 years, 45 to <60 years and 60 to ≤80 years). RA rheumatoid arthritis, mRA modified SCORE by application of the European League Against Rheumatism 1.5 multiplication factor in patients with RA, axSpA axial spondyloarthritis, PsA psoriatic arthritis. Low to moderate risk (SCORE <5%); high risk (SCORE 5 < 10%); very high risk (SCORE ≥10%)

Fig. 4

Relative risk and percentage of patients with rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis who had a relative risk corresponding to no increased risk (RR = 1), a two-fold risk (RR = 2) or a risk three times or higher (RR = 3–12) compared to individuals without cardiovascular risk factors (no smoking, systolic blood pressure ≤120 mmHg or total cholesterol ≤4 mmol/L)