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Cardiovascular risk factors are negatively associated with rheumatoid arthritis disease outcomes
Kangping Cui1, Mohammad Movahedi2, Claire Bombardier2
1Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada.
Insights
Cardiovascular disease risk factors, even without established disease, are linked to increased rheumatoid arthritis (RA) disease activity and disability. Managing these risk factors may improve RA outcomes and prevent cardiovascular events.
Area of Science:
- Rheumatology
- Cardiovascular Medicine
- Clinical Epidemiology
Background:
- Rheumatoid arthritis (RA) is a known risk factor for cardiovascular disease (CVD).
- The impact of CVD risk factors on RA disease activity and patient-reported disability is not well understood.
- Understanding this relationship is crucial for comprehensive patient management.
Purpose of the Study:
- To investigate the association between cardiovascular disease (CVD) risk factors and rheumatoid arthritis (RA) disease activity and disability.
- To determine if CVD risk factors, in the absence of established CVD, influence RA outcomes.
- To explore a potential dose-response relationship between the number of CVD risk factors and RA severity.
Main Methods:
- A cross-sectional analysis was conducted using data from the Ontario Best Practices Research Initiative RA registry.
- Participants were categorized into three groups: no CVD/no risk factors, CVD risk factors only, and established CVD.
- Multivariable regression models assessed the association between CVD status and RA disease activity (DAS28-ESR, CDAI) and disability (HAQ-DI).
Main Results:
- Approximately 50% of the 2033 RA patients had at least one CVD risk factor.
- The presence of one or more CVD risk factors was independently associated with significantly higher RA disease activity scores (CDAI, DAS28-ESR) and disability (HAQ-DI).
- A dose-response relationship was observed, with multiple CVD risk factors correlating with greater disease activity and disability.
Conclusions:
- Cardiovascular disease risk factors, even in isolation, are significantly associated with increased disease activity and disability in rheumatoid arthritis patients.
- These findings underscore the importance of identifying and managing CVD risk factors in RA patients.
- Effective management of CVD risk factors may not only prevent cardiovascular events but also improve overall RA outcomes.
Aims:
Rheumatoid arthritis (RA) is associated with cardiovascular disease (CVD), but the influence of CVD risk factors on RA outcomes is limited. We examined if CVD risk factors alone are associated with RA disease activity and disability.
Methods:
We performed a cross-sectional analysis of participants in the Ontario Best Practices Research Initiative, RA registry. Patients were categorized into mutually exclusive CVD categories: (1) No established CVD and no CVD risk factors; (2) CVD risk factors only including ⩾1 of hypertension, dyslipidemia, diabetes, or smoking; or (3) history of established CVD event. Multivariable regression analyses examined the effect of CVD status on Disease Activity Score 28 (DAS28-ESR), Clinical Disease Activity Index (CDAI), and Health Assessment Questionnaire Disability Index (HAQ-DI) scores at baseline.
Results:
Of 2033 patients, 50% had at least 1 CVD risk factor, even in the absence of established CVD. The presence of ⩾1 CVD risk factor was independently associated with higher CDAI [β coefficient 1.59, 95% confidence interval (CI) 0.29-2.90, p = 0.02], DAS28-ESR (β coefficient 0.20, 95% CI 0.06-0.34, p = 0.01) and HAQ-DI scores (β coefficient 0.15, 95% CI 0.08-0.22, p < 0.0001). The total number of CVD risk factors displayed a dose response, as >1 CVD risk factor was associated with higher disease activity and disability, compared with having one or no CVD risk factors.
Conclusion:
CVD risk factors alone, or in combination, are associated with higher disease activity and disability in RA. This emphasizes the importance of risk factor recognition and management, not only to prevent CVD, but also to improve potential RA outcomes.
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