Background There is a recognized excess burden of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) as compared to the general population. Several studies suggested reduced CVD mortality in RA in recent decades [1-3]. Longitudinal studies on trends in occurrence of CVD events in RA patients over time, and studies comparing trends in CVD events in RA vs general population are lacking.
Objectives 1) To assess trends in incidence of CVD in patients with incident RA in 1980-2009; and 2) To compare incidence of CVD in RA patients vs non-RA subjects with RA incidence/index date in 2000-09.
Methods The study population comprised Olmsted County, Minnesota residents with incident RA (age >18 years, 1987 ACR criteria met in 1980-2009) and non-RA subjects from the same underlying population with similar age, sex and calendar year of index. All subjects were followed until death, migration, or 12/31/2016. Follow-up was truncated for comparability. Incident CVD events included myocardial infarction (MI), stroke (ischemic or hemorrhagic), coronary heart disease (CHD) death and first occurrence of any of these. Patients with CVD events prior to RA incidence/index date were excluded. Cox proportional hazards models were used to compare incident CVD events by decade, adjusting for age and sex. Cumulative incidence of CVD events adjusted for death from other causes was also computed.
Results The study included 906 patients with RA (mean age 55.9 years; 69% female). There were 201, 299 and 406 patients with incident RA in 1980-89, 1990-99 and 2000-09, respectively. During median follow-up of 10.6, 10.4 and 10.2 years per decade, CVD events occurred in 31, 38, and 31 patients. Patients with incident RA in 2000–09 had markedly lower cumulative incidence of any CVD events than patients diagnosed in 1990s and 1980s (Figure). Hazard ratios (HR) for any CVD events demonstrated significant reduction in CVD events among patients with incident RA in 2000s compared with incident RA in 1980s (HR: 0.52; 95% confidence interval (CI): 0.32-0.86) and a reduction approaching significance compared with incident RA in 1990s (HR: 0.65; 95% CI: 0.40-1.05).
Patients with incident RA in 2000s were compared with 405 patients without RA in 2000s who experienced 30 CVD events during follow-up. Patients with incident RA in 2000s had no excess in CVD events over subjects without RA (HR: 0.88, 95% CI: 0.53-1.46). Results were similar for MI, stroke and CHD deaths when examined separately.
Conclusion Our findings show a dramatic reduction in incidence of major CVD events in RA in recent decades. The gap in CVD occurrence between RA patients and the general population may be closing. These findings may reflect increased awareness, improved primary CVD prevention and more optimal RA disease management in recent years. More studies are needed to understand the reasons and implications of these trends.
References  Myasoedova E, et al. J Rheumatol2017, 44(6):732-9.
 Kerola AM, et al. Clin Exp Rheumatol2015, 33(3):391-8.
 Lacaille D, et al. Ann Rheum Dis2017, 76(6):1057-63.
Disclosure of Interests Elena Myasoedova Grant/research support from: Pfizer, John Davis Grant/research support from: Pfizer, Veronique Roger: None declared, Sara Achenbach: None declared, Cynthia S. Crowson: None declared
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