Major cardiovascular events associated factors in a cohort of patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic autoimmune disease with articular and extra-articular manifestations. Mortality in RA is influenced by an increased risk of cardiovascular events by up to 48% (RR: 1.48, 95% CI 1.36-1.62), with a higher standardized mortality rate (SMR) due to cardiovascular causes compared to the general population. Our main objective was to examine the effect of clinical and serological variables on the risk of major cardiovascular events (MCE) in a cohort of RA patients.

This was a retrospective cohort study. Patients more tha 18 years old and active follow-up in the RA care models of Hospital Universitario Clínica San Rafael and Clínica Nogales were included. Patients with prior major cardiovascular events or polyautoimmunity syndromes before the RA diagnosis were excluded. Survival analysis was performed to evaluate the probability of remaining free of MCEs, along with Cox proportional hazards analysis and structural equation modeling using a PATH analysis to assess direct and indirect effects.

A total of 406 patients were included, 342 (84%) of whom were women, with a mean age of 44.8±13.1 years and a disease duration of 13±13.4 months. The average DAS28 activity score was 2.5±1.78, with 48.7% having active disease (DAS28>2.6). Nineteen patients experienced MCEs, resulting in a cumulative incidence (CI) of 4.68% (4.4% myocardial infarction and 1.4% stroke). The most frequent risk factors were hypertension (23.7%) and smoking (24.8%). Bivariate analysis showed that heart failure (RR=1.58, 95% CI 1.12-2.23, p=0.01), and hypertension (RR=2.36, 95% CI 1.22-4.60, p<0.01) were significantly associated with MCEs. The probability of MCE-free survival at six months post-diagnosis was 50%. In the Cox model, only hypertension and age at diagnosis were significantly associated with MCE outcomes. In the PATH analysis, dyslipidemia was significantly associated with myocardial infarction without a mediating effect from corticosteroids (coef=1.83, p<0.001).

Traditional risk factors increase the risk of MCEs in RA patients. Additionally, dyslipidemia acts as an independent risk factor without mediation by other variables, making it a therapeutic target for preventing these outcomes.