The incidence of cardiovascular disease (CVD) in patients with incident rheumatoid arthritis (RA) has improved during recent decades, according to results of a population-based cohort study published in The Journal of Rheumatology.
Previous studies have reported a 1.5- to 2-fold increased risk for CVD events in patients with RA, compared with the general population. CVD is the major cause of premature mortality in this population. Studies in recent years, however, have suggested an improved CVD mortality in patients diagnosed with RA after 2000.
The objectives of the current study were to determine trends in incidence of CVD and mortality following CVD events in patients with incident RA from 1980 to 2009, and compare these with the general population.
The study included adults from Olmsted County, Minnesota, with a diagnosis of RA from January 1, 1980, to December 31, 2009, and randomly selected Olmsted County residents without RA who were of similar age, sex, and calendar year of index. Data from the medical records were collected until death, migration, or December 31, 2016. Patients with CVD events before incidence of RA or index date were excluded.
The primary outcome was any CVD event, defined as the first of either myocardial infarction or stroke.
The study cohort included 905 patients with RA (mean age, 55.9 years; 69% women), including 201 patients with incident RA from 1980 to 1989, 299 from 1990 to 1999, and 405 from 2000 to 2009. A control group from the general population comprised 904 patients without RA, including 201 patients in the 1980s, 299 patients in the 1990s, and 404 patients in the 2000s.
After adjustment for age and sex, the risk for any CVD event in patients with RA in the 2000s was 42% lower than in the 1980s (hazard ratio [HR], 0.58; 95% CI, 0.34-0.98). Although the risk for stroke was not significantly different in patients with RA in the 2000s than in the 1980s, the risk for myocardial infarction was 56% lower in more recent cohorts (HR, 0.44; 95% CI, 0.20-0.97). However, following adjustment for antirheumatic medication use, all associations were attenuated.
Even though the risk for any CVD event in patients with RA in the 1980s and 1990s was increased compared with the control groups, patients with incident RA in the 2000s were not at increased risk for myocardial infarction or stroke, compared with those without RA.
The risk for mortality after a CVD event in patients with RA in the 1990s was lower than in the 1980s (HR, 0.54; 95% CI, 0.33-0.90), and the risk in patients with RA in the 2000s was lower than in the 1980s (HR, 0.68; 95% CI, 0.33-1.41).
The study had several limitations, including the potential for miscoding of the CVD events, potential selection bias because patients with chronic inflammatory conditions other than RA were not excluded, and because included patients were predominantly White, the results may not apply to other populations.
“[T]hese findings highlight an important milestone in CVD disease management, opening grounds for investigation of the reasons for these trends with implications for patients with rheumatic diseases and beyond,” concluded the researchers.
Myasoedova E, Davis JM 3rd, Roger VL, Achenbach SJ, Crowson CS. Improved incidence of cardiovascular disease in patients with incident rheumatoid arthritis in the 2000s: a population-based cohort study. J Rheumatol. Published online Feb 15, 2021. doi:10.3899/jrheum.200842