Background/Purpose:

Compared with the general population, patients with rheumatoid arthritis (RA) have an increased risk of cardiovascular disease or events (CE): stroke, Myocardial Infarction (MI), Congestive Heart Failure (CHF) and Cardiovascular Mortality (CVM). Systemic inflammation is the cornerstone of both RA and atherosclerosis. Over the past fifteen years, new treatment strategies such as tight control, treat to target, methotrexate optimization, biologic DMARDs use has allowed a better control of this inflammation.

Objective: The aim of this systematic review was to assess the excess risk of presenting a CE in RA patients as compared to general population, for all studies and, before and after 2000.

Methods: We systematically searched literature (via Pubmed and Cochrane library) up to March 2016 for observational studies providing data about the occurrence of a CE (among stroke, MI, CHF, CVM) in patients with RA and in a control group. A meta-analysis of the relative risk (RR) concerning patients with RA in relation to the control group was performed for each cardiovascular event and for each period (before and after 2000).

Results:

Out of 5714 screened references, 28 studies were included. There was a significant increased risk for all CEs among people with RA relative to the general population.

For studies realized before 2000, a significant increased risk of CEs was observed in RA patients:

– RR=1.32 [1.24; 1.41], p<0.00001 for MI.

– RR=1.25 [1.14; 1.32], p<0.00001 for CHF

– RR=1.21 [1.15; 1.26], p<0.00001 for CVM

– RR=1.12, [95 % CI 1.04; 1.21], p<0.002 for stroke

For all studies realized after the year 2000, the excess risk of MI was significantly reduced in comparison with the period before 2000: RR=1.18 [1.14; 1.23], p<0.00001; the increased risk was not retrieved for CHF (RR= 1.17 [0.88; 1.56], p=0.27) and CVM (RR=1.07 [0.74; 1.56], p=0.71). The excess risk of stroke was stable: RR=1.23 [1.06; 1.43], p=0.006.

Discussion: This meta-analysis confirms an increased risk of CEs among people with RA relative to the general population. It also appears that this excess risk is less prevalent than prior to 2000s. This might have two explanations: a better management of the cardiovascular risk in patients with RA and a better control of chronic systemic inflammation thanks to new therapeutic strategies.

Conclusion: The cardiovascular excess risk of RA patients relative to the general population seems to be decreased since 2000, especially for MI and CVM. This suggests that the recent improvements in RA management may have a positive impact on cardiovascular comorbidities.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/decrease-in-cardiovascular-event-excess-risk-in-rheumatoid-arthritis-since-2000-a-meta-analysis-of-controlled-studies/