Background In the general population it is well documented that females have their CVD diagnosed at a later stage compared to males. Wether this is true also for rheumatoid arthritis (RA) patients is not known.
Objectives To evaluate if cardiovascular disease (CVD) risk prediction and event rates differed between the sexes, and if adjustments for traditional and RA specific risk factors were of importance.
Methods RA cohorts from 13 rheumatology centers were compared. Data on CVD risk factors and RA characteristics were collected at baseline; CVD outcomes were collected using standardized definitions. Standardized incidence ratios (SIR) were calculated with respect to sex using the following risk calculators FRS, SCORE, ACC/AHA and QRISK II.
Results 5638 patients with RA and no prior CVD were included (mean age: 55.3 [SD: 14.0] years, 76% female). During a mean follow-up of 5.8 (SD: 4.4) years, 437 patients developed CVD events. SIRs (95% CI) using the various CVD risk calculators were for females and males: FRS: 1.02 (0.80, 1.31) and 0.86 (0.67, 1.12) (p=0.19), SCORE: 0.34 (0.17, 0.67) and 0.25 (0.11, 0.58) (p=0.98), ACC/AHA: 0.72 (0.50, 1.04) and 0.56 (0.36, 0.88) (p=0.74) and QRISKII 0.61 (0.47, 0.79) and 0.52 (0.35, 0.79) (p=0.42). The 10 year CVD-free survival differed significantly between the sexes, when adjusting for a) age, b) age and CVD risk factors and c) age, CVD risk factors and RA disease characteristics (Females [mean %±SD] 88.3±0.3, males 79.4±0.4), p<0.001 for all (Figure).
Conclusions In a large international cohort of patients with RA, there was no sex difference in the ability of the various risk calculators to predict CVD. CVD-free survival was significantly higher in females, even after adjustments for both traditional and RA specific risk factors.
Acknowledgement ATACC-RA collaborators: T.K. Kvien (Diakonhjemmet hospital, Oslo, Norway), E.L. Matteson (Mayo Clinic, Rochester, United States), K. Douglas and A. Sandoo (Dudley Group NHS Foundation Trust, West Midlands, United Kingdom), E. Arts and J. Fransen (Radboud University Medical Centre, Nijmegen, Netherlands), P.P. Sfikakis and E. Zampeli (University of Athens, Athens, Greece), S. Rantapää-Dahlqvist and S. Wållberg-Jonsson and L. Innala (University of Umeå, Umeå, Sweden), G. Karpouzas (Harbor UCLA Medical Center RHU, Torrance, United States), D. Solomon and K. Liao (Harvard Medical School Brigham and Women's Hospital, Boston, United States), M.A. Gonzalez-Gay and A. Corrales (Hospital Universitario Marques de Valdecilla, Santander (Cantabria), Spain), P.H. Dessein and L. Tsang (University of Witwatersrand, Johannesburg, South Africa), H. El-Gabalawy and C. Hitchon (University of Manitoba, Winnipeg, Manitoba, Canada), V.P. Ramos and I.C. Yáñez (Instituto Nacional de Ciencias Médicas y Nutriciόn Salvador Zubirán, México City, Mexico), M. van de Laar and H. Vonkeman and I. Meek (Hospital Medisch Spectrum Twente, Enschede, Netherlands), E. Husni and R. Overman (Cleveland Clinic, Cleveland, United States), I. Colunga and D. Galarza (Hospital Universitario “Dr. José E. González”, Monterrey, Mexico)
Disclosure of Interest None declared