The incidence and prevalence of major adverse cardiovascular events in patients with rheumatoid arthritis (RA) do not differ significantly compared with those with psoriatic arthritis (PsA) or axial spondyloarthritis (axSpA), implying that inflammation, rather than a particular disease state, drives the increased risk for cardiovascular disease (CVD) in these individuals. The results of this mixed retrospective and prospective cohort study were published in Arthritis Care & Research.
Data from patients with RA, PsA, and axSpA from the Swiss Clinical Quality Management registry were analyzed. The primary outcome was a composite of myocardial infarction, transient or permanent cerebrovascular event, or CV-associated death. A total of 5315 patients were eligible for the incidence analysis, with a total follow-up time of 37,495 patient-years for RA, 19,837 patient-years for axSpA, and 9171 patient-years for PsA.
The unadjusted incidence rate of major adverse cardiovascular events per 1000 patient-years was 2.67 for RA, 1.41 for axSpA, and 1.42 for PsA. Compared with patients with RA, unadjusted incidence rate ratios (IRRs) were 0.53 for axSpA (95% CI, 0.34-0.80; P =.003) and 0.53 for PsA (95% CI, 0.30-0.95; P =.03).
After adjustments for traditional CV risk factors, age at disease onset, sex, and duration of disease, no statistically significant differences were reported between patients with RA and those with axSpA (adjusted IRR, 0.93; 95% CI, 0.51-1.69; P =.80) or between those with RA and those with PsA (adjusted IRR, 0.56; 95% CI, 0.27-1.14; P =.11). Similar results were demonstrated with the analysis of prevalence.
The investigators concluded that on the basis of the study findings, which suggest that the inflammatory process is responsible for an increased risk for CV disease, traditional risk factors for major adverse cardiovascular events, including smoking, hypertension, and hyperlipidemia, need to be considered in these patient populations. They emphasize the importance of detection and management of traditional CV risk factors in patients with RA, as well as in those with PsA and axSpA.
CG has received research fees from Roche, Pfizer, AB2 Bio, and consultant and speaker’s fee from Roche, Pfizer, Abbvie, MSD, BMS, Sanofi-Regeneron, Novartis, AB2 Bio. DC received consulting fees from BMS, Pfizer, and Janssen. AF has received consultancies or honoraria from Abbvie, AB2 Bio, BMS, MSD, Pfizer, Roche, and UCB.
Lauper K, Courvoisier DS, Chevallier P, Finckh A, Gabay C. Incidence and prevalence of major adverse cardiovascular events in rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis [published online April 2, 2018]. Arthritis Care Res (Hoboken). doi: 10.1002/acr.23567