Background/Purpose: Arterial vascular events have a great impact in the morbidity and mortality of rheumatoid arthritis (RA). Traditional and nontraditional risk factors for arterial vascular events vary widely among different ethnic groups. Few studies have been conducted in Hispanics from the United States. Thus, we determined the factors associated with the occurrence of arterial vascular events in a cohort of Hispanics from Puerto Rico with RA. 

Methods: RA patients (per American College of Rheumatology classification criteria) of Puerto Rican ethnicity (self and four grandparents) were studied to determine the demographic features, health-related behaviors, clinical manifestations, disease activity (per disease activity score 28 [DAS28]), comorbid conditions, functional status (per Health Assessment Questionnaire [HAQ]), and pharmacologic profile associated with arterial vascular events. An arterial vascular event was defined as the occurrence of myocardial infarction, angina pectoris, vascular procedure for coronary artery disease, stroke, or peripheral artery disease. Patient characteristics were analyzed by bivariable (chi-square and Student’s t tests) and multivariable (logistic regression) analyses.  

Results: In total, 405 RA patients were studied. The mean (standard deviation [SD]) age was 56.1 (13.9) years and the mean (SD) disease duration was 15.0 (50.7) years; 87.2% were woman. Forty-three patients (10.6%) had at least one incident arterial vascular event. In the bivariable analyses, patients with arterial vascular events were more likely to be male (23.3% vs. 11.6%, p= 0.031) and older (63.0 [11.1] vs. 55.2 [14.0] years, p<0.001) and to have more extra-articular manifestations (69.8% vs. 48.9%, p=0.010), disease activity (DAS28 score, 4.21 [1.81] vs. 3.61 [1.45], p=0.044 ), functional disability (HAQ score, 1.40 [0.89] vs. 1.09 [0.78], p=0.017 ), arterial hypertension (83.7% vs. 51.7%, p<0.001),  diabetes mellitus (25.6% vs. 13.8%, p=0.041), dyslipidemia (81.0% vs. 45.3%, p<0.001) and peripheral venous disease (11.6% vs. 3.9%, p=0.040) than those without arterial vascular events. No differences were found for disease duration, smoking, exercise, body mass index, joint deformities, erosive disease, and exposure to nonsteroidal anti-inflammatory drugs, corticosteroids, disease modifying anti-rheumatic drugs and biologic agents. In the multivariable analysis adjusted for gender and age, extra-articular manifestations (OR=2.08, 95% CI 1.03-4.20), functional status (OR=2.52, 95% CI 1.24-5.11), arterial hypertension (OR= 3.43, 95% CI 1.40-8.41), dyslipidemia (OR= 4.48, 95% CI 2.00-10.04) and peripheral venous disease (OR=2.93, 95% CI .96-8.97) retained significance.  

Conclusion: This is the first study examining the prevalence and correlates of arterial vascular events in Hispanics from Puerto Rico with RA. Patients with extra-articular manifestations and greater disability as well as those with traditional risk factors for cardiovascular disease were at higher risk. Awareness of these factors may lead to more effective management strategies of patients at risk for arterial vascular events.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/arterial-vascular-events-in-hispanics-from-puerto-rico-with-rheumatoid-arthritis/