Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis

Cynthia S. Crowson*, Silvia Rollefstad, Eirik Ikdahl, George D. Kitas, Piet L.C.M. van Riel, Sherine E. Gabriel, Eric L. Matteson, Tore K. Kvien, Karen Douglas, Aamer Sandoo, Elke Arts, Solveig Wållberg-Jonsson, Lena Innala, George Karpouzas, Patrick H. Dessein, Linda Tsang, Hani El-Gabalawy, Carol Hitchon, Virginia Pascual Ramos, Irazä Contreras YáñezPetros P. Sfkakis, Evangelia Zampeli, Miguel A. Gonzalez-Gay, Alfonso Corrales, Mart van de Laar, Harald E. Vonkeman, Inger Meek, Anne Grete Semb

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

112 Citations (Scopus)

Abstract

Objectives: Patients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA.

Methods: In 13 rheumatology centres, data on CVD risk factors and RA characteristics were collected at baseline. CVD outcomes (myocardial infarction, angina, revascularisation, stroke, peripheral vascular disease and CVD death) were collected using standardised definitions.

Results: 5638 patients with RA and no prior CVD were included (mean age: 55.3 (SD: 14.0) years, 76% women). During mean follow-up of 5.8 (SD: 4.4) years, 148 men and 241 women developed a CVD event (10-year cumulative incidence 20.9% and 11.1%, respectively). Men had a higher burden of CVD risk factors, including increased blood pressure, higher total cholesterol and smoking prevalence than women (all p<0.001). Among the traditional CVD risk factors, smoking and hypertension had the highest population attributable risk (PAR) overall and among both sexes, followed by total cholesterol. The PAR for Disease Activity Score and for seropositivity were comparable in magnitude to the PAR for lipids. A total of 70% of CVD events were attributable to all CVD risk factors and RA characteristics combined (separately 49% CVD risk factors and 30% RA characteristics).

Conclusions: In a large, international cohort of patients with RA, 30% of CVD events were attributable to RA characteristics. This finding indicates that RA characteristics play an important role in efforts to reduce CVD risk among patients with RA

Original languageEnglish
Pages (from-to)48-54
Number of pages7
JournalAnnals of the rheumatic diseases
Volume77
Issue number1
DOIs
Publication statusPublished - Jan 2018
Externally publishedYes

Keywords

  • UT-Hybrid-D

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