Cardiovascular Risk in Rheumatoid Arthritis Higher Than in Type 2 Diabetes

Investigators assessed the risk for cardiovascular disease in patients with rheumatoid arthritis vs patients with diabetes and the general population.

Patients with rheumatoid arthritis (RA) have a more-than-doubled risk for cardiovascular (CV) events compared with patients with diabetes, suggesting that systemic inflammation may be an independent contributor to CV risk, according to study results published in the Journal of Rheumatology.

Researchers from The Netherlands compared data from 2 cohorts of patients — the CARdiovascular research and RhEumatoid arthritis (CARRÉ) study cohort and the Hoorn study cohort — to evaluate the risk for incident cardiovascular disease (CVD) in patients with RA vs patients with diabetes and the general population.

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The CARRÉ cohort included patients ages 50 to 75 years who were diagnosed with RA between 1989 and 2001. In total, 353 patients with RA were enrolled between January 2001 and January 2002 and prospectively followed over 15 years. The Hoorn cohort included a randomly assigned selection of 2484 men and women between ages 50 and 75 years who participated in an “extensive and repeated” CV screening program.

At baseline, investigators collected demographic data, medical and family histories, and medication use. In addition, data were collected on a selection of RA-specific markers and traditional CV risk factors, including Disease Activity Score, C-reactive protein, smoking status, systolic and diastolic blood pressure, body mass index, and cholesterol.

Within the CARRÉ cohort, 95 patients developed a CV event over an 11-year median follow-up period (range, 2 months-15 years) or a total follow-up of 2973 patient-years (PY). The CV incidence rate was 3.2/100 PY. In the Hoorn cohort, 257 participants developed a CV event (median follow-up 12 years [range, 1 month-12 years]) over 18,874 PY. The CV incidence rate was 1.36/100 PY.

After performing age- and sex-adjusted analyses, researchers found that CV event hazard ratios (HRs) increased in patients with RA (HR 2.07; 95% CI, 1.57-2.72; P <.01) and in patients with diabetes (HR 1.51; 95% CI, 1.02-2.22; P =.04) compared with participants without diabetes.

After additional adjustment for CV risk factors, HRs were still increased among patients with RA (HR 1.82; 95% CI, 1.32-2.50; P <.01). The highest HRs for developing CVD were in patients with both RA and diabetes (HR 2.21; 95% CI, 1.01-4.8; P =.046) or RA and insulin resistance (HR 2.67; 95% CI, 1.3-5.46; P <.01).

One study limitation is that the Hoorn study was conducted 10 years before the CARRÉ study, during which time the definition of diseases and disease assessment and management best practices may have changed. In addition, researchers noted that the presence of treatment with methotrexate and biologic drugs among the cohorts is not “representative of the current clinical practice.

“Our study demonstrates a more than twofold higher CV risk in participants with RA when compared with the non-diabetic general population,” the researchers concluded. “[A]djustment for CV risk factors still results in a significant residual [CVD] risk for patients with RA, indicating that systemic inflammation is likely an independent contributor to CV risk in RA.”


Agca R, Hopman LHGA, Laan KCJ, et al. Cardiovascular event risk in rheumatoid arthritis is higher than in type 2 diabetes: a 15 year longitudinal study [published online May 15, 2019]. J Rheumatol. doi:10.3899/jrheum.180726