In patients with rheumatoid arthritis (RA), knowledge regarding the impact of various risk factors for cardiovascular disease (CVD) events is essential for the establishment of individualized risk evaluation and prevention. According to the results of a study published in the Annals of the Rheumatic Diseases, optimal management of CVD risk factors continues to be a key objective of CVD risk management in patients with RA.1
Data on CVD risk factors and RA characteristics were collected at baseline from 13 rheumatology centers. CVD outcomes — myocardial infarction, angina, revascularization, stroke, peripheral vascular disease, and CVD death — were based on standardized definitions. A total of 5638 patients (mean age, 55.3 ± 14.0 years; 76% women) with RA and no previous CVD were included in the study.
At a mean follow-up of 5.8 ± 4.4 years, 148 men and 241 women experienced a CVD event (10-year cumulative incidence of 20.9% and 11.1%, respectively). A higher burden of CVD risk factors — increased blood pressure, higher total cholesterol levels, and smoking prevalence — was reported among men compared with women (P <.001 for all). Of the traditional risk factors for CVD, smoking and hypertension were associated with the highest population attributable risk (PAR) overall and for both genders.
The PAR for Disease Activity Score and for RA seropositivity (presence of rheumatoid factor and anticitrullinated protein antibodies) were both comparable in magnitude with the PAR for lipid levels. Overall, 70% of CVD events were attributable to all CVD risk factors (49%) and RA characteristics (30%).
In this large, international study of patients with RA, no significant gender differences were observed regarding the effect of the various risk factors on the later development of CVD. Optimal management of CVD risk factors remains an important goal of CVD risk management in the RA patient population, as demonstrated by the substantial proportion of CVD events attributable to CVD risk factors. Moreover, the sizable percentage of CVD risks attributable to RA characteristics suggests that RA disease activity and severity play key roles in efforts to reduce CVD risk in patients with RA.
Crowson CS, Rollefstad S, Ikdahl E, et al; A Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis (ATACC-RA) Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis [published online September 6, 2017]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2017-211735