Rheumatoid Arthritis May Be Associated With Risk for Major Adverse Cardiovascular Events

The presence of rheumatoid arthritis (RA), particularly seropositive and active RA, may be associated with increased risk for major adverse cardiovascular events (MACE), according to study results published in RMD Open.

Researchers sought to assess the risk for MACE and death in patients with RA vs those without RA who were referred for cardiac computed tomography (CT) for chest pain. Data for this registry-based follow-up study were obtained from the Western Denmark Heart Registry collected from 9 cardiac centers between 2008 and 2016. Data of patients diagnosed with RA were assessed through the Danish National Patient Registry. The primary outcome of the study was a composite of myocardial infarction, ischemic or unspecified stroke, percutaneous coronary intervention, coronary artery bypass grafting, and all-cause mortality.

A total of 42,257 patients were included in this study, 0.8% of whom had a diagnosis of RA (median RA duration, 6.5 years) with an incidence rate for revascularization in patients with RA and those without RA of 3.4 and 3.7 per 1000 person-years, respectively. In this cohort, Compared with participants without RA, patients with RA tended to be older (median age, 67.7 vs 57.2 years, respectively), to be women (76% vs 56%, respectively), and to have more comorbidities. Patients with RA vs those without RA were also more likely to have calcium scores >0 (49.7% vs 40.2%, respectively), hypertension (55.9% vs 45.8%, respectively), and treatment with lipid-lowering drugs (40.0% vs 33.7%, respectively) and oral glucocorticoids (22.3% vs 4.3%, respectively).

The incidence rate for the primary study outcome was higher in patients with RA vs those without RA (24.4 vs 14.0 per 1000 person-years, respectively; adjusted hazard ratio [aHR], 1.35; 95% CI, 0.93-1.96). Patients treated for RA flares more than once in the 3 years preceding cardiac CT and patients with seropositive RA had an increased risk for MACE (aHR, 1.80 [95% CI, 1.08-3.00] and aHR, 1.42 [95% CI, 0.93-2.16], respectively).

The risk for cardiovascular events was not found to depend on the type of RA treatment that patients received. Patients treated with conventional synthetic disease-modifying antirheumatic drugs (DMARDs) had an incidence rate of 14.4 per 1000 person-years (aHR, 1.38; 95% CI, 0.91-2.11) compared with an incidence rate of 18.4 per 1000 person-years for patients treated with biologic DMARDs (aHR, 1.25; 95% CI, 0.56-2.79).The secondary outcome of the study was a composite of myocardial infarction, ischemic and unspecified stroke, and coronary artery bypass grafting. The incidence rate of the secondary outcome was 15.7 and 8.2 per 1000 person-years in patients with and without RA, respectively (aHR, 1.58; 95% CI, 0.99-2.52). The incidence rate of the secondary outcome in patients with RA treated for flares before cardiac CT was 21.6 per 1000 person-years vs 11.7 per 1000 person-years in patients who had not received treatment for flares (HR, 2.21; 95% CI, 1.18-4.13). The incidence rate of the secondary outcome in patients with seropositive RA was 18.1 per 1000 person-years vs 7.6 per 1000 person-years in participants with seronegative RA (aHR, 1.79; 95% CI, 1.03-3.10). No difference in the incidence of the secondary outcome was noted with DMARD treatment type.

Study limitations included a dataset with relatively few events, the use of multiple composite end points, high number of patients with RA treated with oral glucocorticoids, and a lack of generalizability due to the patient selection process.

“In patients referred to cardiac CT due to chest pain, we found a trend of an association between RA and the combined primary outcome, supporting that RA per se, but in particular seropositive and active RA, may increase the risk [for] [coronary artery disease] even after initial [coronary artery disease]  diagnosis and treatment,” the researchers concluded.

Reference

De Thurah A, Andersen IT, Tingaard AB, et al. Risk of major adverse cardiovascular events among patients with rheumatoid arthritis after initial CT-based diagnosis and treatment. RMD Open. 2020;6(1):e001113.