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Cardiovascular Event Risk in Rheumatoid Arthritis Compared with Type 2 Diabetes: A 15-year Longitudinal Study

Rabia Agca1,2, Luuk H G A Hopman3,4, Koen J C Laan3,4

  • 1From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands. r_agca@hotmail.com.

The Journal of Rheumatology
|May 17, 2019
PubMed

Insights

Patients with rheumatoid arthritis (RA) face more than double the risk of cardiovascular disease (CVD) events compared to the general population. This elevated CVD risk in RA persists even after accounting for traditional risk factors, highlighting inflammation

Area of Science:

  • Rheumatology
  • Cardiology
  • Epidemiology

Background:

  • Cardiovascular disease (CVD) risk is significantly elevated in patients with rheumatoid arthritis (RA).
  • Long-term follow-up studies investigating this increased CVD risk in RA are limited.

Purpose of the Study:

  • To prospectively investigate cardiovascular disease (CVD) incidence and risk factors in patients with longstanding rheumatoid arthritis (RA).
  • To compare CVD risk in RA patients against a reference cohort, including individuals with type 2 diabetes (DM).

Main Methods:

  • The CARRÉ study is a prospective cohort study involving 353 patients with longstanding RA.
  • Cardiovascular endpoints were assessed over 15 years and compared to a reference cohort of 2540 individuals.
  • Statistical analysis included age- and sex-adjusted hazard ratios (HR) and adjustments for traditional CV risk factors.

Main Results:

  • The incidence rate of CV events in RA patients was 3.20 per 100 person-years, more than double the reference cohort's rate (1.36 per 100 person-years).
  • RA patients had a 2.07-fold increased risk of CV events compared to controls, which remained significant (HR 1.82) after adjusting for CV risk factors.
  • Patients with both RA and type 2 diabetes (DM) or insulin resistance exhibited the highest CVD risk.

Conclusions:

  • Established rheumatoid arthritis (RA) is associated with a more than twofold increased incidence of cardiovascular events compared to the general population.
  • The heightened CVD risk in RA patients exceeds that seen in type 2 diabetes (DM) and is independent of traditional cardiovascular risk factors.
  • Systemic inflammation in RA appears to be a significant, independent contributor to cardiovascular risk.
Abstract

Keywords:
CARDIOVASCULAR DISEASECARDIOVASCULAR RISKRHEUMATOID ARTHRITISTYPE 2 DIABETES MELLITUS

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