Background/Purpose:  Cardiovascular (CV) disease is a prevalent comorbidity in patients with rheumatoid arthritis (RA). However, recent cohort studies with long term follow up studying this risk are scarce. We report the results of a 15 year observational cohort study comparing the risk of CV events in patients with RA to the general population and participants with type 2 diabetes (DM).

Methods:  The CARRÉ study is a prospective cohort study with the purpose of investigating CV disease and its risk factors in a random sample of 353 patients with longstanding RA. CV endpoints were assessed at baseline, 3, 10 and 15 years of follow up and compared to the Hoorn Study population (n=2540), a cohort representative of the general population designed to analyze glucose metabolism and CV risk factors over 15 years. Incidence rates per 100 person-years were calculated and Cox regression analyses were performed to investigate CV risk in these persons.

Results:  96 patients with RA developed a CV event during 2703 person-years of follow up resulting in an incidence rate of 3.6 per 100 person-years. In the Hoorn Study population, 298 individuals developed a CV event, of which 41 had DM, during a follow up of 25335 person-years, resulting in an incidence rate of 1.4 per 100 person-years in the general population. Age and sex adjusted hazard rates (HR) for CV events were increased for RA (2.14 [95% CI 1.65-2.78, P<0.01]) and DM (1.63 [95% CI 1.17 – 2.27, P<0.01]) compared to the general population (figure 1). HR was significantly increased in RA (1.73 [95% CI 1.27 – 2.35, P<0.01]) and reached borderline significance in DM (1.42 [95% CI 1.00 – 2.00, P=0.047]) after additional adjustment for traditional CV risk factors (figure 2). Exclusion of prevalent CV disease resulted in increased HR for RA (2.16 [95% CI 1.53 – 3.04, P<0.01]) and not for DM (1.28 [95% CI 0.83 – 1.98, P=0.27]) compared to the general population after adjustment for traditional CV risk factors.

Conclusion:  The incidence rate of CV events was 3.6 per 100 person-years in patients with established RA which is more than double that of the general population. RA patients have an increased risk of CV endpoints comparable to type 2 DM. This increased risk remains for RA patients even after adjustment for traditional CV risk factors, indicating that the (ongoing) systemic inflammation of RA is an independent contributor to CV risk.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-risk-of-cardiovascular-events-in-patients-with-rheumatoid-arthritis-over-a-15-year-time-period-that-is-comparable-to-type-2-diabetes/