Each 20-mg/L increase in C-reactive protein (CRP) concentration among individuals with rheumatoid arthritis (RA) was associated with a 1% rise in 10-year cardiovascular risk, according to study results published in European Journal of Internal Medicine.
The researchers used the Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA) to assess the association between CRP level and CV risk. They conducted a cross-sectional study that comprised 1251 participants without previous cardiovascular events (age 60.4±9.3 years; 78% women; disease duration 11.6±8 years). All participants were sourced from the Cardiovascular Obesity and Rheumatic Disease Study (CORDIS) database. Among the study participants, 43% (n=539) received glucocorticoids, 54% (n=676) received a biologic or targeted synthetic disease-modifying antirheumatic drug (DMARD), and 70.4% (n=885) received at least 1 conventional synthetic DMARD. Multivariate regression was used to examine associations between ERS-RA risk score and individual variables.
The mean 10-year ERS-RA score was 12.9±10% among all study participants. After adjustments were performed for DMARD and biologic use, a significant association was observed between CRP concentrations and 10-year cardiovascular event risk (coefficient of 0.005 for each successive 10-mg/L increase in CRP [95% CI, 0.000-0.111]; P =.047). Disease activity did not account for the association between CRP and ERS-RA.
Limitations of the study included an inability to determine causality, the use of immunosuppressive and anti-inflammatory therapy among participants and its potential to affect the strength of the correlation between CRP and ERS-RA score, potential misestimation of cardiovascular risk factor prevalence, and the unavailability of CRP plasma concentrations among all participants with RA.
The study authors concluded, “[I]n a large cohort of RA patients without previous cardiovascular events, a significant, positive, and independent association between CRP plasma concentrations and 10-year cardiovascular risk estimated by ERS-RA.” The authors also noted that the findings “support the concept that measures to reduce the residual inflammatory burden may limit the incidence of cardiovascular events in the RA population.”
Erre GL, Cacciapaglia F, Sakellariou G, et al. C-reactive protein and 10-year cardiovascular risk in rheumatoid arthritis. Eur J Int Med. Published online July 9, 2022. doi:10.1016/j.ejim.2022.07.001