Background Patients with rheumatoid arthritis (RA) have an increased risk of cardiovascular disease (CVD). CV risk factors and scoring algorithms vary by country but comparisons have not been performed for RA.
Objectives To compare CV risk factors, scoring algorithms and outcomes in RA patients from 7 countries.
Methods RA cohorts from 8 rheumatology centers in UK, Norway, Netherlands, USA, Sweden, Greece and South Africa were compared. Data on CV risk factors, algorithms (SCORE and Framingham) and RA characteristics were collected at baseline for each cohort; CV outcomes were collected prospectively using standardized definitions. Chi-square and rank sum tests were used to compare risk factors and algorithms; Kaplan-Meier methods were used to compare CV event rates between centers.
Results 3176 RA patients without prior CVD were included (mean age: 55 [SD: 14] years, 73% female). During a mean follow-up of 7.8 years (24733 total person years), 314 patients developed CVD. Disease duration varied by center: 2 with early RA (<1 year duration), 4 established (mean 9-13 years) RA and 1 with both. Mean age varied from 53 to 61 years (younger in the early RA cohorts - p<0.001); females varied from 66% to 87% (p<0.001). 1 cohort consisted of Hispanics, the rest Caucasians. All CV risk factors (smoking status, blood pressure, hypertension, lipids, diabetes mellitus, body mass index and use of antihypertensive or antilipemic medications), SCORE and Framingham algorithms and RA characteristics (rheumatoid factor and/or anti-citrullinated protein antibody seropositivity, disease activity scores [DAS28] and acute phase reactants) differed significantly across centers, p<0.001 for each comparison. Mean risk scores were highest in Norway, UK, Netherlands, and Sweden. However, CV event rates were lowest in Norway and UK and highest in South Africa, Netherlands, US-Mayo and Sweden.
Conclusions Statistically (but not necessarily clinically) significant differences in CV risk factors, algorithms and RA characteristics exist among RA cohorts from different countries. Misalignment between CV event rates and risk algorithms across RA cohorts illustrates the need for RA-specific and possibly country-specific risk algorithms.
Acknowledgements Sherine Gabriel, Cynthia Crowson, George Kitas, Karen Douglas, Anne Grete Semb, Silvia Rollefstad, Eirik Ikdahl, Piet Van Riel, Elke Arts, Jaap Fransen, Solbritt Rantapää-Dahlqvist, Solveig Wållberg-Jonsson, Lena Innala, George Karpouzas, Petros P. Sfikakis, Evi Zampeli, Patrick H. Dessein, Linda Tsang, Miguel A. Gonzalez-Gay, Alfonso Corrales, Hani El-Gabalawy, Carol Hitchon, Virginia Pascual Ramos, Irazú Contreras Yáñez, Daniel Solomon, Katherine Liao.
Disclosure of Interest None declared
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