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. 2018 Jan;77(1):48-54.
doi: 10.1136/annrheumdis-2017-211735. Epub 2017 Sep 6.

Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis

Cynthia S Crowson  1   2 , Silvia Rollefstad  3 , Eirik Ikdahl  3 , George D Kitas  4 , Piet L C M van Riel  5 , Sherine E Gabriel  2   6 , Eric L Matteson  2 , Tore K Kvien  3 , Karen Douglas  4 , Aamer Sandoo  4   7 , Elke Arts  5 , Solveig Wållberg-Jonsson  8 , Lena Innala  8 , George Karpouzas  9 , Patrick H Dessein  10   11 , Linda Tsang  11 , Hani El-Gabalawy  12 , Carol Hitchon  12 , Virginia Pascual Ramos  13 , Irazú Contreras Yáñez  13 , Petros P Sfikakis  14 , Evangelia Zampeli  14 , Miguel A Gonzalez-Gay  15 , Alfonso Corrales  15 , Mart van de Laar  16 , Harald E Vonkeman  16 , Inger Meek  16 , Anne Grete Semb  3 ; A Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis (ATACC-RA)
Collaborators, Affiliations

Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis

Cynthia S Crowson et al. Ann Rheum Dis. 2018 Jan.

Abstract

Objectives: Patients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA.

Methods: In 13 rheumatology centres, data on CVD risk factors and RA characteristics were collected at baseline. CVD outcomes (myocardial infarction, angina, revascularisation, stroke, peripheral vascular disease and CVD death) were collected using standardised definitions.

Results: 5638 patients with RA and no prior CVD were included (mean age: 55.3 (SD: 14.0) years, 76% women). During mean follow-up of 5.8 (SD: 4.4) years, 148 men and 241 women developed a CVD event (10-year cumulative incidence 20.9% and 11.1%, respectively). Men had a higher burden of CVD risk factors, including increased blood pressure, higher total cholesterol and smoking prevalence than women (all p<0.001). Among the traditional CVD risk factors, smoking and hypertension had the highest population attributable risk (PAR) overall and among both sexes, followed by total cholesterol. The PAR for Disease Activity Score and for seropositivity were comparable in magnitude to the PAR for lipids. A total of 70% of CVD events were attributable to all CVD risk factors and RA characteristics combined (separately 49% CVD risk factors and 30% RA characteristics).

Conclusions: In a large, international cohort of patients with RA, 30% of CVD events were attributable to RA characteristics. This finding indicates that RA characteristics play an important role in efforts to reduce CVD risk among patients with RA.

Keywords: Cardiovascular disease; population attributable risk; rheumatoid arthritis; risk factor.

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Conflict of interest statement

Competing interests: CSC reports grants from National Institute of Arthritis and Musculoskeletal and Skin Disease of the National Institutes of Health during the conduct of the study. AGS has received speaker honoraria and/or consulting fee from Merck/Schering-Plough, Abbott, BMS, UCB, Pfizer/Wyeth, Eli Lilly and Hoffmann-La Roche. TKK reports grants and personal fees from AbbVie, BMS, Biogen, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira/Pfizer, Merck-Serono, MSD, Mundipharma, Novartis, Oktal, Orion Pharma, Roche, Sandoz and UCB. SR, EI, GDK, PLCMvR, SEG, ELM, KD, AS, EA, SW-J, LI, GK, PHD, LT, HE-G, CH, VPR, ICY, PPS, EZ, MAG-G, AC, MvdL, HEV and IM: none declared.

Figures

Figure 1
Figure 1
Cumulative incidence of cardiovascular disease (CVD) among men (solid line) and women (dashed line) with rheumatoid arthritis according to age
Figure 2
Figure 2
Population attributable risk for cardiovascular risk factors and RA characteristics overall (panel A), among women (panel B) and among men (panel C).
See this image and copyright information in PMC

Comment in

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