Background Atherosclerosis has an inflammatory basis and use of several immunosuppressive agents has been associated with reduced risk of cardiovascular (CV) events in epidemiologic studies of rheumatoid arthritis (RA). However, it is unknown whether cumulative disease activity in RA correlates with CV events.
Objectives To determine the relationship between cumulative disease activity as measured by the Clinical Disease Activity Index (CDAI) and CV events.
Methods We studied patients with RA followed in a longitudinal registry. Cumulative disease activity was assessed with the area under the curve for CDAI, a validated measure of RA disease activity, during follow-up. Age, sex, traditional CV risk factors (hypertension, hyperlipidemia, diabetes, tobacco use, body mass index, and family history of MI), known CV disease, and baseline immunosuppressive use were assessed at the start of follow-up and included in adjusted models. Cox proportional hazards regression models were used to determine the risk of a composite CV endpoint that included myocardial infarction, stroke, and CV death.
Results 24,989 subjects followed for a median of 2.3 years were included in these analyses. During follow-up, we observed 422 CV endpoints for an incidence rate of 9.08 (95% confidence interval, CI, 7.90 – 10.26) per 1,000 person-years. In models adjusting for age, gender, known CV disease, other traditional CV risk factors, and baseline medications, a 10-point reduction in cumulative CDAI was associated with a 26% reduction in CV risk (95% confidence interval 17-34%). These results were robust in sensitivity analyses (see Fig. 1) stratified by known CV disease, use of corticosteroids, use of non-steroidal anti-inflammatory drugs or selective COX-2 inhibitors, and change in RA treatment.
Conclusions Reduced cumulative disease activity in RA is associated with fewer CV events. This may be relevant for treat to target strategies.
Acknowledgements This study is sponsored by CORRONA. In the last 2 years, AbbVie, Amgen, AstraZeneca, Genentech, Horizon Pharma, Eli Lilly, Novartis, Pfizer, Vertex, and UCB have supported CORRONA through contracted subscriptions.
Disclosure of Interest D. Solomon Grant/research support: Amgen, Lilly, Pfizer, CORRONA, G. Reed Employee of: CORRONA, J. Kremer Shareholder of: CORRONA, J. Curtis: None declared, M. Farkouh Consultant for: Genentech, L. Harrold Grant/research support: CORRONA, M. Hochberg: None declared, P. Tsao: None declared, J. Greenberg Shareholder of: CORRONA, Consultant for: Astra Zeneca, Pfizer, Employee of: CORRONA