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Explaining the cardiovascular risk associated with rheumatoid arthritis: traditional risk factors versus markers of
Daniel H Solomon1, Joel Kremer, Jeffrey R Curtis
1Brigham and Women's Hospital, Boston Massachusetts 02115, USA. dhsolomon@partners.org
Insights
Both traditional cardiovascular risk factors and rheumatoid arthritis severity markers predict cardiovascular events in RA patients. Increasing numbers of both factor types are associated with higher cardiovascular event risk.
Area of Science:
- Rheumatology
- Cardiology
- Epidemiology
Background:
- Cardiovascular disease poses a significant threat to patients with rheumatoid arthritis (RA).
- The distinct contributions of traditional cardiovascular risk factors and RA disease activity markers to cardiovascular event prediction remain unclear.
Purpose of the Study:
- To evaluate the relative importance of traditional cardiovascular risk factors and rheumatoid arthritis severity markers in predicting cardiovascular events.
- To assess the combined predictive power of these factors for cardiovascular outcomes in RA patients.
Main Methods:
- A prospective longitudinal cohort study utilizing data from the CORRONA registry in the USA.
- Analysis of baseline data from 10,156 RA patients to identify predictors of cardiovascular outcomes (myocardial infarction, stroke, transient ischemic attack).
- Logistic regression and receiver operating characteristic (c-statistic) analysis were used to assess the discriminatory value of traditional cardiovascular risk factors and RA severity markers.
Main Results:
- During a median follow-up of 22 months, 76 primary cardiovascular events occurred (rate: 3.98 per 1000 patient-years).
- The predictive model's discriminatory ability (c-statistic) improved from 0.57 (CV risk factors only) to 0.67 (CV risk factors + age/gender) and 0.71 (CV risk factors + RA severity markers).
- Individuals with higher numbers of both traditional cardiovascular risk factors and RA severity markers exhibited a significantly increased incidence of cardiovascular events.
Conclusions:
- Both traditional cardiovascular risk factors and rheumatoid arthritis severity markers are significant contributors to cardiovascular event prediction models in RA patients.
- An increasing burden of both traditional cardiovascular risk factors and RA disease activity markers is associated with a progressively higher risk of cardiovascular events.
Background:
Cardiovascular (CV) disease has a major impact on patients with rheumatoid arthritis (RA), however, the relative contributions of traditional CV risk factors and markers of RA severity are unclear. The authors examined the relative importance of traditional CV risk factors and RA markers in predicting CV events.
Methods:
A prospective longitudinal cohort study was conducted in the setting of the CORRONA registry in the USA. Baseline data from subjects with RA enrolled in the CORRONA registry were examined to determine predictors of CV outcomes, including myocardial infarction, stroke or transient ischemic attack. Possible predictors were of two types: traditional CV risk factors and markers of RA severity. The discriminatory value of these variables was assessed by calculating the area under the receiver operating characteristic curve (c-statistic) in logistic regression. The authors then assessed the incidence rate for CV events among subjects with an increasing number of traditional CV risk factors and/or RA severity markers.
Results:
The cohort consisted of 10 156 patients with RA followed for a median of 22 months. The authors observed 76 primary CV events during follow-up for a composite event rate of 3.98 (95% CI 3.08 to 4.88) per 1000 patient-years. The c-statistic improved from 0.57 for models with only CV risk factors to 0.67 for models with CV risk factors plus age and gender. The c-statistic improved further to 0.71 when markers of RA severity were also added. The incidence rate for CV events was 0 (95% CI 0 to 5.98) for persons without any CV risk factors or markers of RA severity, while in the group with two or more CV risk factors and three or more markers of RA severity the incidence was 7.47 (95% CI 4.21 to 10.73) per 1000 person-years.
Conclusions:
Traditional CV risk factors and markers of RA severity both contribute to models predicting CV events. Increasing numbers of both types of factors are associated with greater risk.
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