Background Patients with rheumatoid arthritis (RA) are at increased risk of coronary heart disease (CHD) overall, as well as death from CHD. A direct impact of chronic inflamation on the vascular system, secondary effects of physical inactivity and some drugs used in the management of RA are shown as the reasons for the increase in this comorbidity (1).
Objectives We aim to determine the frequency of CHD in the RA patients who receive biological agents.
Methods Hacettepe University Biologic Registry (HUR-BIO) includes demographic and clinical data of patients treated with biological agent since 2005. By August 2016, 1235 RA patients were recorded in the database. Age, smoking status, comorbidities, current and previous treatments were analysed in 1000 patients. Disease activity was estimated by the 28-joint activity calculator (DAS28-ESR) and DAS28-CRP. Functional assesment was evaluated by the Health Assessment Questionnaire (HAQ). Premature CHD should be defined if clinical CHD or sudden death is documented in male younger than 55 years of age and in female younger than 65 years of age.
Results Overall 1000 patients (79,8% female) were enrolled in this study. Mean age was 53,1±12,6 years old, mean disease duration was 12,3±9,3 years. CHD was detected 57 (5,7%) patients and female/male was 38/19. Premature CHD was observed in 38 (66,7%) patients. CHD patients had more frequently male, older, higher classical risk factors, higher baseline ESR level and higher functional disability (Table). HAQ score also remained high in CHD group at last visit. Classical cardiovascular risk factors, sex, seropositivity, disease activity score and HAQ score were similar in the premature and other CHD group. Coronary artery stenting, coronary artery bypass surgery and medical treatment was applied in 12 (21%), 20 (35,1%) and 25 (43,9%) CHD patients, respectively. There was no statistical difference in treatment of premature and other CHD.
Conclusions As a results CHD were detected in 5,7 percents of RA patients who are receiving biological agents. Importantly, two third of these patients have premature CHD. Classical risk factors are observed more frequently in CHD patients as expected but interestingly, no additional risk factors other than age were detected between premature and other CHD patients. This suggests that the primary factor triggers premature CHD is the underlying inflammatory rheumatic disease. The presence of CHD was determined by patient history which the limitation of our study. We did not assess to subclinical CHD in this study.
Comorbidity in rheumatoid arthritis, Carl Turesson, Swiss Medical Weekly, 2016.
Disclosure of Interest None declared
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