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OP0166 Sustained Development of Cardiovascular Disease in Rheumatoid Arthritis Despite Cardioprotective Treatment: The 10-Year Prospective Carre-Study
  1. A. M. Van Sijl1,2,3,
  2. I. A. van den Oever1,2,
  3. M. J. Peters3,
  4. V. V. van Halm4,
  5. A. E. Voskuyl2,
  6. Y. M. Smulders3,
  7. M. T. Nurmohamed1,2,3
  1. 1Rheumatology, Reade, Jan Van Breemen Research Institute
  2. 2Rheumatology
  3. 3Internal Medicine and Institute for Cardiovascular Research (ICaR), VU University Medical Center
  4. 4Cardiology, Academic Medical Center, Amsterdam, Netherlands


Background Rheumatoid arthritis (RA) is a chronic inflammatory joint disease which is associated with an increased cardiovascular (CV) risk. It is still unknown to what extent this is due to CV risk factors or the underlying inflammatory process in RA. With the advent of effective anti-inflammatory and cardioprotective treatment, this risk might be mitigated or even reduced.

Objectives The present study compared changes in CV risk factors, RA-related factors and medication use over time in RA-patients who did and did not develop CV disease during follow-up.

Methods Starting from 2000-2001, 10-year incidence rate of CV disease, CV risk factors, RA-related factors and medication use were assessed in a prospective cohort of 353 RA patients at baseline, at 3-years and at 10-years of follow-up. Associations between the changes in RA related factors and development of CV disease were assessed using generalized estimating equation (GEE) analyses, while changes in all variables were assessed with general linear models (GLM).

Results After 10 years, there were 58 CV events over 2361 patient years of follow-up, incidence rate (IR) of 25.3/1.000 patientyears. This was similar to the IR at 3-years of follow-up: 22.8/1.000 patientyears. GLM analyses showed that use of antihypertensives, statins, TNF inhibitors and general CV risk increased significantly over time in the entire population, while RA related factors improved significantly (see enclosed figure). GEE analyses showed that increased use of TNF inhibitors was positively associated with less incident CV disease.

Conclusions The risk of incident CV disease persists in patients with RA despite the advent of effective anti-inflammatory therapies and increased use of cardioprotective medication in recent years. Patients who used TNF inhibitors and, more indirectly, had a reduction in inflammation or disease activity, were less at risk of developing a CV disease. General CV risk and use of cardioprotective medications did not attenuate this association.

Disclosure of Interest None Declared

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