Significant Trend in Reduction of Cardiovascular Deaths Reported Among Patients With Rheumatoid Arthritis

The number of deaths from cardiovascular disease (CVD) has declined significantly since 2000 in people with rheumatoid arthritis (RA),¹ according to a study presented by Elena Myasoedova, MD, PhD, assistant professor of medicine in the Department of Internal Medicine at the Mayo Clinic, at the 2015 annual meeting of the American College of Rheumatology in San Francisco.

Results of this comparative study of patients with RA before and after the year 2000 showed an important trend toward reduction of both CVD and cardiovascular mortality among those diagnosed since 2000.

The association between RA and increased risk of CVD and  CVD death is well documented.² “There has been no apparent signal for this increased cardiovascular risk to be declining,” Dr Myasoedova explained, noting that  few studies have looked at risk of cardiovascular death associated with RA, especially in those who are recently diagnosed with the condition.  It was unclear, she said, whether the risk is changing in the era of improved diagnostics and early effective treatments.

The study compared CVD mortality in a group of 498 people diagnosed with RA between 1990 and 1999 to that in 315 individuals diagnosed between 2000 and 2007.  All participants were followed until their death or upon moving out of the study area. The rate of CVD mortality before 2000 was 7.9%, which declined in the after group to 2.8%, for an overall improvement trend in CVD mortality of 57% from one decade to the next.

Results for reductions in mortality among patients diagnosed with comorbid coronary heart disease (CHD) and RA were even more pronounced: the rate declined from 4.7% before 2000 to 1.2% after, for a reduction of 80%.

“Potential contributors to these improving trends are unknown but may include improved diagnostics, early effective treatments currently available for patients with RA, and increased awareness and improved management of increased cardiovascular disease risk in RA,” Dr Myasoedova reported.

Reduction in risk of death from CVD, and specifically from CHD, among patients with RA diagnosed after 2000 was the same as that observed in normal controls from the same period, suggesting an overlap of benefits from the improved management of CVD in general.

Dr Myasoedova concluded that, “While the reasons for the recent improvement in cardiovascular mortality are uncertain, continued efforts toward early diagnosis and early effective antirheumatic treatment, as well as more vigilant cardiovascular screening and management according to current guidelines of cardiovascular disease management appear to be justified and are likely to be beneficial to people with this disease.”

References

1. Myasoedova E, Crowson CS, Matteson EL, Davis JM III, Therneau TM, Gabriel SE. Decreased cardiovascular mortality in patients with incident rheumatoid arthritis (RA) in recent years: dawn of a new era in cardiovascular disease in RA? Presentation at: 2015 ACR/AHRP Annual Meeting; November 7-11, 2015; San Francisco, CA. Abstract 3237.
2. Giles JT.  Cardiovascular disease in rheumatoid arthritis: current perspectives on assessing and mitigating risk in clinical practice.  Best Pract Res Clin Rheumatol. 2015;29:597-613.