Treat-to-Target Strategy Lowers Cardiovascular Risk in Rheumatoid Arthritis

The treat-to-target approach for conventional cardiovascular risk factors may be effective in reducing the risk for cardiovascular disease among individuals with rheumatoid arthritis (RA), according to a study recently published in the Annals of the Rheumatic Diseases.

This randomized controlled trial included 320 participants with RA and no history of diabetes mellitus or cardiovascular disease (mean age, 52.5 years; 69.7% women). Of these, a total of 219 participants finished the full 5-year follow-up period. Participants were randomly assigned to receive either usual care for conventional cardiovascular risk factors (n=158) or a treat-to-target intervention (n=162). Progressing carotid intima media thickness through follow-up terminus was the primary outcome of the study, with a secondary outcome of first incidence of nonfatal or fatal cardiovascular event. Progression of carotid intima media thickness was set as the dependent variable in a generalized linear model, with carotid intima media thickness assessor and sex used as adjusting covariates. The least square method was used to compute the mean difference in carotid intima media thickness.

The treat-to-target group showed a significantly lower progression of carotid intima media thickness than the usual care group, with 0.023 mm (95% CI, 0.011-0.036 mm) vs 0.045 mm (95% CI, 0.030-0.059 mm), respectively (P =.028). The treat-to-target group experienced 2 cardiovascular events (1.3% of group), whereas the usual care group experienced 7 (4.7% of group; P =.048), resulting in a between-group difference of 3.4% (95% CI, 0.04%-7.2%). Researchers identified 10 participants who had a baseline cardiovascular risk greater than 10%, and among these individuals, treatment reduced both low-density lipoprotein (LDL) cholesterol and blood pressure levels. In addition, their carotid intima media thickness decreased by -0.056 mm over 5 years.

Limitations to this study included a considerable dropout rate, a limited conclusive scope using carotid intima media thickness as an end point, a lack of blinding in measuring carotid intima media thickness, the lack of an independent committee in determining clinical end points, and an LDL cholesterol target that should have been stricter.

The study researchers conclude that “the present study provides support for a treat-to-target approach of traditional cardiovascular risk factors in subjects with well-controlled RA.”

Study author M Castro Cabezas reports financial associations with Merck.

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Reference

Burggraaf B, van Breukelen-van der Stoep DF, de Vries MA, et al. Effect of a treat-to-target intervention of cardiovascular risk factors on subclinical and clinical atherosclerosis in rheumatoid arthritis: a randomised clinical trial [published online January 4, 2019]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2018-214075