Rheumatoid arthritis versus diabetes as a risk factor for cardiovascular disease, a cross sectional study. The CARRÉ Investigation

V P van Halm ¹, M JL Peters ¹, A E Voskuyl ¹, M Boers ², W F lems ³, M Visser ¹, C DA Stehouwer ⁴, A MW Spijkerman ¹, J M Dekker ¹, G Nijpels ¹, R J Heine ¹, L M Bouter ¹, Y M Smulders ¹, B AC Dijkmans ¹ and M T Nurmohamed ^2*

¹ VU University Medical Center, Netherlands
² VUMC, Netherlands
³ Vrije Universiteit Medisch Centrum, Netherlands
⁴ University Hospital Maastricht, Netherlands

^* To whom correspondence should be addressed. E-mail: m.nurmohamed{at}janvanbreemen.nl.

Accepted 3 August 2008

Abstract

objectives: Patients with rheumatoid arthritis (RA) have an increased cardiovascular risk, but the magnitude of this risk is not precisely known. We therefore investigated the associations between RA and type 2 diabetes (DM2), a well-established cardiovascular risk factor, on the one hand and cardiovascular disease (CVD) on the other.

Methods: We determined the prevalences of CVD, (i.e. coronary, cerebral and peripheral arterial disease), in 353 randomly selected outpatients with RA (diagnosed between 1989 and 2001, aged between 50 and 75 years; the CARRÉ study), and in participants of a population-based cohort study on diabetes and CVD (the Hoorn study). RA patients with normal fasting glucose levels from the CARRÉ study (RA, n = 294) were compared to individuals from the Hoorn study with a normal glucose metabolism (non-diabetic, n = 258), and individuals with DM2 (DM2, n = 194).

Results: The prevalence of CVD was 5.0% (95%-CI: 2.3-7.7%) in non-diabetic, 12.4% (95%-CI: 7.5-17.3%) in DM2, and 12.9% (95%-CI: 8.8-17.0%) in RA individuals. With non-diabetic individuals as reference category, the age- and gender-adjusted prevalence odds ratio (ORs) for CVD was 2.3 (95%-CI: 1.1-4.7) for individuals with DM2 and 3.1 (95%-CI: 1.6-6.1) for RA patients. There was an attenuation of the prevalences after adjustment for conventional cardiovascular risk factors (ORs: 2.0 (95%-CI: 0.9-4.5) and 2.7 (95%-CI: 1.2-5.9), respectively).

Conclusions: The prevalence of CVD in RA is increased to an extent that is at least comparable to that of DM2. This should have implications for primary cardiovascular prevention strategies in RA.