Rheumatoid Arthritis Confers Higher 10-Year Cardiovascular Risk Than Osteoarthritis

Patients with rheumatoid arthritis (RA) have a significantly higher 10-year risk for cardiovascular (CV) events compared with patients with osteoarthritis (OA), according to study findings published in the European Journal of Internal Medicine.

The cross-sectional, multicenter study evaluated the prevalence of CV risk factors and estimated the 10-year CV risk in patients with RA and OA. Data were obtained from the Cardiovascular Obesity and Rheumatic DISease (CORDIS) Study Group of the Italian Society of Rheumatology database. The Systematic COronary Risk Evaluation (SCORE) and the Progetto Cuore algorithms were used to assess the CV risk.

A total of 1467 patients with RA (mean [SD] age, 59.8 [11.5] years; 78.3% women) with no history of CV events and 342 age- and sex-matched patients with OA (mean age, 58.7 [11.5] years; 79.8% women) were included. Patients with RA had a higher rate of diabetes (9.9% vs 6.4%, respectively; P = .04) and a lower rate of dyslipidemia (21.7% vs 32.5%, respectively; P < .0001) compared with patients with OA. The RA and OA groups had a similar prevalence of hypertension (40% vs 39.2%, respectively). In addition, patients with RA had a significantly lower body mass index vs patients with OA (25.6 ± 4.8 kg/m² vs 26.6 ± 4.4 kg/m², respectively; P < .0001), and patients with RA were more frequently smokers vs patients with OA (20.4% vs 12.5%, respectively; P = .002).

The mean 10-year estimated risk for a first fatal CV event was 1.6% (95% CI, 1.3-1.9) in patients with RA and 1.4% (95% CI, 1.3-1.6) in patients with OA (P = .002), according to the SCORE chart. The Progetto Cuore algorithm showed that the 10-year risk for fatal and nonfatal CV events was 6.5% (95% CI, 6.1-6.9) for patients with RA, and 4.4% (95% CI, 3.9-5.1) for patients with OA (P < .0001).

The researchers noted that their main study limitation was the cross-sectional design, which limited the ability to evaluate the effect of modifiable disease-related variables such as inflammatory markers or disease activity on the risk for CV events. Also, the RA-related variables did not adequately reflect the natural fluctuation of inflammatory burden observed in these patients because they were collected at a single timepoint.

“Besides controlling RA activity, the application of SCORE and/or Progetto Cuore models in RA patients to stratify individual CV risk is mandatory in clinical practice, eventually also with the application of imaging techniques to correctly classify high-risk patients,” stated the investigators. “Subsequently, specific preventive measures should be implemented to control traditional risk factors, particularly avoiding smoking and improving blood pressure and glycemic levels, to reduce CV morbidity and mortality of RA patients.”

Reference

Cacciapaglia F, Spinelli FR, Piga M, et al. Estimated 10-year cardiovascular risk in a large Italian cohort of rheumatoid arthritis patients: data from the Cardiovascular Obesity and Rheumatic DISease (CORDIS) Study Group. Eur J Intern Med. Published online October 14, 2021. doi:10.1016/j.ejim.2021.10.001