Rates of subclinical and clinical atherosclerosis in patients with rheumatoid arthritis (RA) increases with disease duration, according to results of a 3-year study published in Arthritis Research & Therapy. Atherosclerosis rates were particularly pronounced among patients with disease duration <5 years and type 2 diabetes (T2D).
Investigators abstracted data from the Italian Research Group in Clinical and Experimental Rheumatology, an observational study conducted at multiple rheumatology clinics in Italy. Researchers consecutively enrolled patients fulfilling diagnostic criteria for RA in the Italian Research Group in Clinical and Experimental Rheumatology and collected patient data for ≥3 years. They conducted study assessments at baseline and after 12 and 36 months. The primary outcome measure was occurrence of subclinical and clinical atherosclerosis at the conclusion of follow-up.
Investigators defined subclinical atherosclerosis as the presence of atherosclerotic lesions on carotid and/or peripheral arteries, as determined by ultrasound. They defined clinical atherosclerosis as the presence of one of the following conditions: myocardial infarction, congestive heart failure, or cerebrovascular disease.
Researchers stratified patients by disease duration in the analyses and also captured clinical and demographic risk factors for cardiovascular disease. They used regression analyses to calculate odds ratios (ORs) for comorbid atherosclerosis among patients with certain risk factors.
Researchers analyzed data from 841 participants. Median cohort age was 60 years (range, 21-90 years), with 82.2% of patients being women. Investigators observed subclinical atherosclerosis in 24.1% of participants at the end of follow-up compared with just 16.5% at baseline (203 vs 139 patients; P <.0001). The rate of subclinical atherosclerosis was particularly elevated among patients with disease duration <5 years compared with patients with disease duration >5 years (133 vs 70 patients; P <.0001). According to the logistic regression model, comorbid T2D (OR, 4.5; 95% CI, 1.74-11.62; P =.002), comorbid high blood pressure (OR, 2.03; 95% CI, 1.04-4.14; P =.042), presence of anticitrullinated protein antibodies (OR, 2.36; 95% CI, 1.19-4.69; P =.014), and higher mean C-reactive protein values (OR, 1.07; 95% CI, 1.03-1.14; P =.040) were significantly associated with higher risk for subclinical atherosclerosis.
The rate of clinical atherosclerosis also increased from 5.7% at baseline to 9.0% after 3 years (48 vs 76 patients; P <.0001). As with subclinical atherosclerosis, clinical atherosclerosis was more prevalent among patients with disease duration <5 years compared with disease duration >5 years (P <.0001). Comorbid T2D was associated with an increased risk for clinical atherosclerosis (OR, 6.21; 95% CI, 2.19-17.71; P =.001), although no other potential risk factors produced significant results.
Achieving and maintaining remission was associated with significantly reduced risk for both subclinical (OR, 0.25; 95% CI, 0.11-0.56; P =.001) and clinical atherosclerosis (OR, 0.2; 95% CI, 0.09-0.95; P =.041).
These data indicated an increase in prevalence and incidence of both subclinical and clinical atherosclerosis over a 3-year period, particularly among patients with disease duration <5 years. In addition, researchers identified several risk factors for subclinical and clinical atherosclerosis, most significantly T2D. As remission was associated with a reduced risk for atherosclerosis, investigators emphasized the importance of proper RA treatment in mitigating cardiovascular disease risk.
Ruscitti P, Cipriani P, Liakouli V, et al. Subclinical and clinical atherosclerosis in rheumatoid arthritis: results from the 3-year, multicentre, prospective, observational GIRRCS (Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale) study. Arthritis Res Ther. 2019;21(1):204.