Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are associated with increased risk for early-onset atherosclerotic cardiovascular disease (CVD), independent of traditional atherosclerotic risk factors, according to study results published in The American Journal of Medicine.
Previous studies reported that patients with rheumatic diseases are at increased risk for cardiovascular morbidity and mortality, compared with the general population with traditional risk factors. Limited data suggested accelerated atherosclerosis in patients with rheumatic diseases. Here, the researchers investigate the prevalence of premature and extremely premature atherosclerotic cardiovascular disease.
The researchers used data from the Veterans With Premature Atherosclerosis (VITAL) registry and identified 135,703 patients with first atherosclerotic cardiovascular events at age <55 years for males or <65 years for females (premature atherosclerotic CVD) and 7716 patients who experienced their first cardiovascular event before 40 years of age (extremely premature atherosclerotic CVD). In addition, age-matched patients without atherosclerotic CVD were included in the study.
The primary outcomes included history of premature and extremely premature atherosclerotic CVD in patients with RA, SLE, psoriatic arthritis, and ankylosing spondylitis.
The prevalence of all rheumatic diseases was higher in patients with premature atherosclerotic CVD, compared to those without a rheumatic disease. RA was associated with an increased risk for premature (OR, 1.72; 95% CI, 1.63-1.81) and extremely premature (2.39; 95% CI, 1.85 to 3.08) atherosclerotic CVD. Similarly, SLE was associated with a 69% increased risk for premature (odds ratio [OR], 1.69; 95% CI, 1.56-1.83) and extremely premature (OR, 3.06; 95% CI, 2.38-3.93) atherosclerotic CVD. No such association was discovered for psoriatic arthritis and ankylosing spondylitis.
The study had several limitations, including the observational design, missing data on rheumatic disease duration, severity and treatment, and limited generalizability to other populations.
“Given the elevated risk of early-onset atherosclerotic cardiovascular disease, which was independent of traditional atherosclerotic risk factors, interventions for primary prevention of atherosclerotic cardiovascular disease in such patients require further in-depth analysis and dissemination into clinical practice,” wrote the researchers.
Mahtta D, Gupta A, Ramsey DJ, et al. Autoimmune rheumatic diseases and premature atherosclerotic cardiovascular disease: An analysis from the VITAL (Veterans wIth premaTure AtheroscLerosis) registry [published online Jun 26, 2020]. Am J Med. doi:10.1016/j.amjmed.2020.05.026