Background Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality. This association is thought to be due to the chronic inflammatory disease process, clustering of lifestyle associated CV risk factors, as well as the use of medication such as non steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids in patients with RA. Most studies on CV risk in patients with RA were performed before the introduction of modern powerful anti-inflammatory therapies and intensive treatment strategies aiming at remission. It is important to obtain more information on CV risk in intensively treated RA.
Objectives To evaluate CV event risk and its predictors in intensively treated RA compared to an OA population.
Methods First prospective analysis of occurrence of CV events (myocardial infarction, acute coronary syndrome, coronary intervention, acute heart failure, acute cardiac death) in a cohort of consecutive patients attending the Arthritis Centre Twente (ACT-CVD). All patients with a diagnosis of RA (n=495) or OA (n=208) without previous CV events were included in this study. Inclusion took place between February 2009 and November 2011, follow up data for this analysis were collected onto November 2012. Incidence of CV events in RA and OA groups was compared by Kaplan Meier survival analysis, potential CV event risk factors (age, sex, atherogenic index, current smoking, ESR, IgM RF, DAS28 RA disease activity and RA erosions) within groups were evaluated by logistic regression.
Results At baseline RA and OA groups did not differ in sex (% female; RA=72, OA=78), age (mean years; RA=59, OA=59) and 10-year risk of CV death (mean %; RA=5.7, OA=5.5). The RA group (mean disease duration 7.5 years, 50 % IgM RF positive) was characterized by low disease activity (mean DAS28 2.5, 66% DAS28 remission). After a median follow up of 36 months 46 events had occurred (RA=29, OA=17, p=0.25, figure 1 ). Age, systolic blood pressure and presence of erosions significantly contributed to CV event risk in RA, whereas in age and current smoking significantly contributed to OA associated CV risk.
Conclusions These preliminary data suggest that CV event risk in intensively treated RA equals CV event risk in OA. Factors contributing to CV event risk in rheumatic diseases may be disease specific.
Disclosure of Interest: None Declared