Cardiovascular Case Fatality In Rheumatoid Arthritis Is Decreasing; Results From a Current Low Disease Activity Rheumatoid Arthritis Cohort and Review Of The Literature

Inger L. Meek¹, Harald E. Vonkeman² and Mart A.F.J. van de Laar³, ¹Rheumatology & Clinical Immunology, Rheumatology Center Twente, Medisch Spectrum Twente & Twente University, Enschede, Netherlands, ²Medisch Spectrum Twente & University of Twente, Enschede, Netherlands, ³Rheumatology, Medisch Spectrum Twente & University of Twente, Enschede, Netherlands

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Cardiovascular disease and rheumatoid arthritis (RA)

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects I: Comorbidities in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality. Previous studies, found increased case fatality after myocardial infarction and more frequent sudden death in RA patients compared to non-RA subjects. Trends in case fatality rate in RA after the introduction of potent anti-inflammatory biologic therapies and treat-to-target treatment strategies aiming at remission are not known. The objective of this study was to examine the case fatality rate in current low disease activity RA associated cardiovascular (CV) disease, and to evaluate trends in RA associated CV case fatality over time.

Methods:

Prospective study to determine the incidence of fatal and nonfatal CV events in 480 RA patients included in the ACT-CVD cohort between February 2009 and December 2011. Patients with prior CV disease were excluded. Cox regression analysis was performed to determine CV event risk and contributing risk factors over time. The results of the cohort analysis were put into the context of a review of the literature to evaluate trends in RA associated CV fatality rate over time.

Results:

The study included 480 RA patients, 72.3% female with a median disease duration of 4.2 years, 72.1% being in clinical remission (Disease Activity Score in 28 joints). During a mean follow up of 2.9 years 29 patients (6%, 21/1000 person years) experienced a first CV event, 2 fatal and 27 non-fatal, corresponding to a 6.9 % case fatality rate. Comparison with previous studies in cohorts with successive enrolment periods showed stable high CV event rates in RA cohorts with enrollment between 1955 and 2011, however CV case fatality in these RA cohorts decreased from 52.9% in 1998 to 6.9% in our study.

Conclusion:

CV case fatality in current low disease activity RA is importantly lower than in previous studies. Composite CV event rates remain high, but a trend towards decreasing CV fatality in RA is observed.

Disclosure:

I. L. Meek,
None;

H. E. Vonkeman,
None;

M. A. F. J. van de Laar,
None.

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