Cardiovascular Risk Comorbidities Associated With RA Should Be Considered When Choosing Antirheumatic Therapies

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Researchers analyzed cardiovascular risk comorbidities among patients with rheumatoid arthritis, and the correlation between CV risk and the use of antirheumatic drugs.

Cardiovascular comorbidities are high in patients with rheumatoid arthritis (RA), and risk for cardiovascular events should be accounted for when identifying treatment options, including disease-modifying antirheumatic drugs (DMARDs), according to study results published in Advances in Rheumatology.

Cardiovascular disease (CVD) has been identified as the most common and serious comorbidity among patients with RA due to the increased risk for premature mortality. Patients with CVD are predisposed to systemic arterial hypertension (SAH), diabetes, dyslipidemia, and obesity. Therefore, the objective of RA treatment often includes reducing the risk for cardiovascular mortality. 

To analyze the relationship between cardiovascular risk comorbidities in patients with RA and the use of antirheumatic drugs, researchers conducted a cross-sectional study based on data from the Rheumatoid Arthritis in Real Life (REAL) observational cohort study from Brazil. 

The variables included in the study were drugs used for RA treatment (nonsteroidal anti-inflammatory drugs, glucocorticoids, and biologic or synthetic DMARDs), sociodemographic profile (sex, age, and education), laboratory parameters (duration of RA, presence or absence of erosive disease, rheumatoid factor, anticitrullinated protein antibody, and disease activity using 28 joint counts), and cardiovascular comorbidity risk factors (SAH, DM, and dyslipidemia). Specific cardiovascular events, such as CVD, peripheral vascular disease, acute myocardial infarction (AMI), and congestive heart failure, were also included in the analysis. 

Synthetic DMARDs included in the study were methotrexate, leflunomide, chloroquine/hydroxychloroquine, sulfasalazine, and the Janus kinase inhibitor tofacitinib. Biologic DMARDs (bDMARDs) included were antitumor necrosis factor (TNF) agents (adalimumab, infliximab, etanercept, certolizumab, and golimumab), anti-interleukin (IL) 6r (tocilizumab), abatacept, and rituximab.

A total of 1116 patients with RA were included in the current analysis, of whom 89.4% were women and 63.3% had a cardiovascular comorbidity. Compared with the general population, patients with RA had a higher prevalence of SAH (49.9%) and diabetes (14.9%). According to the researchers and based on previous research, RA has been considered as an independent risk factor for CVD development.

The use of glucocorticoids was observed among 47.4% of patients with RA (n=529), and there was a significant tendency of its lower use in the presence of dyslipidemia (prevalence ratio [PR], 0.790; P =.007).

Further, the higher use of bDMARDs was associated with the presence of cardiovascular comorbidities (PR, 1.147; P =.003).

Researchers noted that anti-TNF agents were the most commonly used bDMARDs (19.9%); however, no association was observed between comorbidities and cardiovascular events and the use of anti-TNF drugs.

The use of abatacept was significantly higher among individuals with vs without RA with cardiovascular comorbidities (PR, 1.194; P =.038). Researchers observed that rituximab use was more frequent among individuals with vs without SAH (PR, 1.327; P =.028), diabetes (PR, 2.006; P =.006), and AMI (PR, 9.073; P <.001). 

Study limitations included the inability to determine a causal relationship between the variables analyzed; the small sample size; and the lack of a formal establishment of cardiovascular risk. However, the researchers suggested that data from this study can be used to demonstrate the need for further studies of cardiovascular risk in patients with RA.

“Given that RA is an independent risk factor for cardiovascular events itself, we highlight the need to better assess the cardiovascular risk of patients in order to guide the choice of different DMARDs, aiming at better cardiovascular outcomes,” the authors concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Vicente GNS, Pereira IA, Werner de Castro GR, et al. Cardiovascular risk comorbidities in rheumatoid arthritis patients and the use of anti-rheumatic drugs: a cross-sectional real-life study. Adv Rheumatol. Published online June 25, 2021. doi:10.1186/s42358-021-00186-4