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Cardiovascular risk in rheumatoid arthritis and diabetes: how does it compare and when does it start?
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  1. Michael T Nurmohamed1,2,3,
  2. George Kitas1,3
  1. 1Department of Internal Medicine, VU University Medical Centre, Jan van Breemen Research Institute, Amsterdam, The Netherlands
  2. 2Department of Rheumatology, VU University Medical Centre, Jan van Breemen Research Institute, Amsterdam, The Netherlands
  3. 3Department of Rheumatology, University of Manchester, Russells Hall Hospital, Manchester, UK
  1. Correspondence to Dr Michael T Nurmohamed, Departments of Internal Medicine and Rheumatology, VU University Medical Centre, PO Box 7057, Amsterdam 1007MB, The Netherlands; mt.nurmohamed{at}vumc.nl

https://doi.org/10.1136/ard.2010.145839

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    There is a substantial amount of evidence for an increased cardiovascular risk in rheumatoid arthritis (RA), 1.5–2-fold in comparison with the general population,1 2 but large-scale studies are still lacking. The majority of the evidence originates from several decades ago, a different era of natural history and management of RA, and thus there is still an unmet need for contemporary large epidemiological studies addressing the magnitude of the cardiovascular risk in RA. These studies should also address if and to what extent the cardiovascular risk in RA is comparable to that of diabetes, an established paradigm for a doubled cardiovascular risk,3 as recent studies have pointed towards this direction.4 5 If confirmed, then this may underpin the need for cardiovascular risk prevention and management in patients with RA, and a possible approach towards achieving this in everyday practice.

    Cardiovascular risk in RA versus diabetes: CARRÉ study

    In a prospective Dutch study, the magnitude of the enhanced cardiovascular risk in RA was investigated by comparing prevalent cardiovascular disease (CVD) with that of diabetes.5 The study comprised 353 RA patients (diagnosed between 1989 and 2001, aged between 50 and 75 years; the CARdiovascular research in RhEumatoid arthritis (CARRÉ) study), and participants of a population-based cohort study on CVD and its risk factors (Hoorn study). Prevalent CVD was observed in 13% patients with RA, 5% in individuals without diabetes and 12% in individuals with type 2 diabetes (n=194), respectively. The OR for CVD, adjusted for age and sex, were 3.1 in RA patients and 2.3 in individuals with type 2 diabetes in comparison with individuals without diabetes. Adjustment for (other) cardiovascular risk factors only slightly attenuated the OR, indicating that RA itself is an independent CVD risk factor. The prospective part of the investigation showed cardiovascular events …

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