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Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis
Cynthia S Crowson1,2, Silvia Rollefstad3, Eirik Ikdahl3
1Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Rheumatoid arthritis (RA) patients face higher cardiovascular disease (CVD) risks. RA characteristics contribute to 30% of these CVD events, highlighting their importance in risk reduction strategies.
Area of Science:
- Rheumatology
- Cardiovascular Medicine
- Epidemiology
Background:
- Patients with rheumatoid arthritis (RA) exhibit an elevated risk of cardiovascular disease (CVD).
- Understanding the specific contributions of traditional CVD risk factors and RA-specific variables is crucial for managing CVD in RA patients.
- Potential sex differences in CVD risk require investigation within the RA population.
Purpose of the Study:
- To assess the impact of cardiovascular disease (CVD) risk factors and rheumatoid arthritis (RA)-specific variables on CVD outcomes.
- To investigate potential sex differences in the relationship between RA, CVD risk factors, and CVD outcomes.
- To quantify the attributable risk of CVD events to both traditional risk factors and RA characteristics.
Main Methods:
- A large, international cohort of 5638 RA patients without prior CVD was established across 13 rheumatology centers.
- Baseline data on traditional CVD risk factors and RA characteristics were collected.
- Standardized definitions were used to collect CVD outcomes during a mean follow-up of 5.8 years.
Main Results:
- During follow-up, 148 men and 241 women experienced a CVD event, with higher 10-year cumulative incidence in men (20.9%) than women (11.1%).
- Men presented a greater burden of CVD risk factors, including higher blood pressure, total cholesterol, and smoking prevalence.
- Smoking and hypertension demonstrated the highest population attributable risk (PAR) among traditional factors, with RA Disease Activity Score and seropositivity showing comparable PAR to lipids.
Conclusions:
- Rheumatoid arthritis (RA) characteristics account for 30% of cardiovascular disease (CVD) events in RA patients.
- These RA-specific factors play a significant role in the elevated CVD risk observed in this population.
- Targeting RA characteristics is essential for comprehensive CVD risk reduction strategies in patients with RA.
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.
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