Background Rheumatoid arthritis (RA) and spondyloarthritis (SpA) are associated with increased cardiovascular (CV) morbidity and mortality, largely attributable to chronic inflammation. However, it has not yet been clarified if the increased CV risk is already present early in the disease process or only after prolonged periods of inflammation.
Objectives To investigate the association between CV comorbidities and early RA (ERA) and early axial SpA (ESpA) in 2 French cohorts, ESPOIR (1) and DESIR (2).
Methods Baseline data of 689 ESPOIR patients (age 48.2±12.1 years, symptom duration 14.2±14.5 weeks) and 645 DESIR patients (age 32.8±8.4 years, axial symptom duration 79.0±45.7 weeks) were analyzed. The most common CV comorbidities were determined in each cohort. The 10-year risk of developing CV disease (CVD) was calculated for every patient using the Framingham and the SCORE equations. The heart age was calculated using the 2008 Framingham points system. The prevalence (95% confidence intervals (95% CI)) of several CV comorbidities was compared to that in the French general population matched for age and gender (arterial hypertension (AHT) data was gathered from the ENNS survey; the rest from statistic reports of the French National Health Insurance Fund for the Employees, including almost 90% of the total French population).
Results 19.0% of ERA patients and 7.1% of ESpA had at least one CVD; the most common was AHT. In ESPOIR, men aged over 55 years had high 10-year CVD risk and women over 60 years had intermediate risk. The heart age exceeded the real age by 4.1±9.6 years in ERA and 2.1±7.0 years in ESpA. AHT prevalence (95% CI) in ESPOIR was increased compared to the general population (18.2% (15.5%>21.3%) vs. 7.6% (6.5%>8.8%)), especially in younger women. No differences were observed for coronary heart disease.
Conclusions Both in ERA and ESpA, we found an increased frequency of CV comorbidities and an increased heart age even after a short duration of symptoms. Moreover, in ERA we found an intermediate to high CVD risk and increased prevalence of AHT compared to the general population. These results should prompt rheumatologists to check these comorbidities already early in disease.
Combe B et al. Joint Bone Spine. 2007 Oct;74(5):440-5.
Dougados M et al. Joint Bone Spine. 2011 Dec;78(6):598-603.
Acknowledgements AMG was supported by a EULAR scientific training bursary for 6 months.
Disclosure of Interest None declared
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