Patients With Early RA Who Receive T2T Management Report Fewer Excess CV Events

Patients with early RA who received treat-to-target management were not found to have excess cardiovascular risk

Compared with matched control participants, patients with early rheumatoid arthritis (RA) who receive treat-to-target (T2T) management do not develop excess cardiovascular (CV) events, according to study findings published in Rheumatology (Oxford).

Subclinical inflammation may be involved in accelerating the development of atherosclerosis in RA. Both RA and atherosclerosis share similar pathways in which key pro-inflammatory mediators, such as tumor necrosis factor (TNF) alpha and interleukin (IL)-6, are involved. A T2T strategy in clinical practice helps attain stable disease activity or remission by suppression of inflammation.

In the observational study, the researchers sought to examine the incidence of CV events among patients whose RA was managed by a T2T approach compared with individuals in a CV risk factor-matched non-RA population and those in a historical RA cohort.

The study included data from the Hong Kong Hospital Authority population-based database, called the Clinical Data Analysis and Reporting System (CDARS),and the Clinical Rheumatology Systemic Treat-to-Target in Asia Leadership (CRYSTAL) registry.

In the CRYSTAL registry, newly diagnosed patients with early RA from major hospitals in Hong Kong who met the European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) 2010 classification for RA, with a baseline disease duration of less than 2 years, were enrolled.

ERA patients managed by a T2T strategy did not develop excess CVE compared with CV risk factor-matched controls over 5 years.

In the current study, each patient with early RA was matched with 3 non-RA control participants who had been selected from CDARS between 2012 and 2016. In addition, patients from the historical RA cohort were included in the study who had been diagnosed with RA between 2002 and 2006 and who did not receive T2T management, with each patient matched with 3 non-RA control participants.

The primary study outcome was the 5-year incidence of CV events between the RA cohort and the control participants. CV events included acute coronary syndrome, ischemic heart disease, heart failure, ischemic cerebrovascular accident, transient ischemic attack/carotid stenosis, and any revascularization intervention.

Secondary study outcomes included the following:

  • Incidence of CV events between the historical RA and control cohort over a period of 5 years.
  • Incidence of CV events between the early RA cohort and the historical RA cohort over a period of 5 years.
  • Differences in the inflammatory burden and treatment used in the early RA vs historical RA cohort.
  • RA-specific (ie, inflammation and treatment) factors for the prediction of CV events among all patients with RA.

Results of the study showed that the incidence of CV events in the early RA and control cohort was similar (hazard ratio [HR], 0.53; 95% CI, 0.15-1.79; P =.30). The incidence of CV events in the historical RA cohort was significantly higher than that in the historical RA control cohort (HR, 1.95; 95% CI, 1.19-3.21; P =.009).

Study limitations included technical issues regarding CDARS, such as data potentially being incomplete and the inability to match for body mass index and family history of CV disease. Further, the relatively small sample size resulted in an overall low absolute CV event incidence in the early RA cohort.

“Patients [with early RA] managed by a T2T strategy did not develop excess CV [events] compared with CV risk factor-matched control [participants] over 5 years,” the researchers concluded.


On LT, Cheng IT, Lam SH, et al. Five-year cardiovascular event risk in early rheumatoid arthritis patients who received treat-to-target management: a case-control study. Rheumatology (Oxford). Published online January 27, 2023. doi:10.1093/rheumatology/kead039