ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1604

Cardiovascular Disease in a Large Incident Cohort of Early Inflammatory Arthritis

Lillian Barra1, Janet E. Pope2, Carol Hitchon3, Gilles Boire4, Daming Lin5, J Carter Thorne6, Diane Tin7, Edward C. Keystone8, Boulos Haraoui9, VP Bykerk6 and CATCH, 1Medicine, Division of Rheumatology, Western University, London, ON, Canada, 2University of Western Ontario, London, ON, Canada, 3University of Manitoba, Winnipeg, MB, Canada, 4Department of Medicine/Division of Rheumatology, Université de Sherbrooke, Sherbrooke, QC, Canada, 5Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, 6University of Toronto, Toronto, ON, Canada, 7The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, 8Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, 9Institut de Rhumatologie de Montréal and University of Montreal, Montreal, QC, Canada

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords:

Session Information

Date: Monday, November 9, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Cardiovascular
Disease in a Large Incident Cohort of Early Inflammatory Arthritis

Background/Purpose:
Rheumatoid Arthritis (RA) is associated with an increased risk of
cardiovascular disease (CVD). The aim of this study is to determine the
incidence and predictors of CVD in Early Inflammatory Arthritis (EIA) from the
Canadian early arthritis cohort (CATCH).

Methods: CATCH
is a multicentre, prospective inception cohort of patients with EIA. Cardiovascular
disease (CVD) was defined as an acute coronary syndrome, percutaneous or
surgical intervention for coronary artery disease, stroke, transient ischemic
attack, peripheral vascular disease requiring surgical intervention or death
secondary to CVD. Pre-existing diagnoses of CVD, risk factors and medications
for CVD were collected at baseline by physician. Incident CVD events and
cardiac medications after study enrollment were self-reported by patients. Stepwise
logistic regression was used to identify predictors for CVD. 

Results:
2652 patients were enrolled in the study with a mean follow-up of 3.4 (SD 2.1)
years. At baseline, 180 (7%) had pre-existing CVD. During the course of
follow-up there were 62 new CVD events in 57 subjects. There were a total of 6 deaths (1 secondary
to CVD). The incidence rate of CVD for years 1, 2, 3, 4 and 5 of the study, respectively
were: 2.3, 4.4, 15.4, 10.4, 10.8 per 1000 person-years. Patients with new CVD
events were older, more likely male and have higher rates of traditional CVD
risk factors (Table 1). Arthritis-related factors were not significantly
associated with the risk of CVD. Independent predictors of CVD were male gender
(OR 1.8 (95% CI: 1.0-3.0), dyslipidemia (OR 1.8 (95% CI: 1.1-3.2)), hypertension
(OR 2.7 (95% CI: 1.6-4.6)) and the use of non-steroidal anti-inflammatories (NSAIDs)
(OR 3.2 (95% CI: 1.8-5.6). Less than 25% of subjects with a CVD diagnosis
reported taking aspirin or cholesterol-lowering drugs during the follow-up
period.

Conclusion:  
The rate of CVD events in patients
with EIA was higher later in the disease course.  CVD appears to be
under-treated and is independently associated with traditional CVD risk factors
and the use of NSAIDs. 

Table 1: Baseline characteristics of EIA patients with a new CVD event
versus those that did not have a new CVD event

 

New CVD

No New CVD

p-value

N

57

2595

 

Age, mean years (SD)

61.2 (13.6)

53.3 (14.8)

<0.0001

Female

31 (54)

1874 (72)

0.0037

Symptom Duration, days mean (SD)

234.8 (129.0)

184.7 (115.9)

<0.0001

Ever Smokera

41 (72)

1441 (56)

0.0136

RA criteriab

52 (93)

2218 (86)

0.1314

Seropositivec

29 (76)

1150 (67)

0.2307

DAS28, mean (SD)

4.87 (1.50)

4.66 (1.45)

0.3017

HAQ, mean (SD)

0.86 (0.67)

0.88 (0.69)

0.8130

Erosionsd

15 (31)

480 (23)

0.2375

CRP, mean (SD) (mg/L)

14.8 (17.9)

13.9 (17.9)

0.7004

ESR, mean (SD)

26.5 (22.8)

26.4 (22.7)

0.9820

Diabetes

9 (16)

210 (8)

0.037

Hypertension

31 (54)

703 (27)

<0.0001

Dyslipidemia

19 (33)

426 (16)

0.0007

DMARDs

50 (88)

2128 (82)

0.2800      

Methotrexate

39 (68)

1712 (65)

0.5458

Biologics

3 (5)

52 (2)

0.1192

Corticosteroids

32 (56)

1271 (49)

0.2674

NSAID

14 (25)

234 (9)

<0.0001

aDefined as past or present smoker

bMeets ACR 1987 RA criteria or ACR/EULAR 2010 RA criteria

cN=1752 with available data on antibodies; seropositive defined as Rheumatoid Factor or Anti-Citrullinated Peptide Antibody positive

dN= 2103 with available data on presence of erosions on plain radiographs

EIA= Early Inflammatory Arthritis, DAS28= Disease Activity Score 28, HAQ= Health Assessment Questionnaire Score, ESR= Erythrocyte Sedimentation Rate, CRP= C-Reactive Protein, , ACR=American College of Rheumatology, RA= Rheumatoid Arthritis, EULAR= European League Against Rheumatism, DMARDs= Disease Modifying Anti-Rheumatic Drugs, NSAID= Non-Steroidal Anti-Inflammatories

 

Disclosure: L. Barra, Roche Pharmaceuticals, 5,Abbott Laboratories, 5,Amgen, 5; J. E. Pope, Abbott,Amgen, Pfizer, Roche, Janssen, BMS, UCB, 5; C. Hitchon, None; G. Boire, None; D. Lin, None; J. C. Thorne, Amgen, Canada, 5; D. Tin, None; E. C. Keystone, Janssen Inc., 2,Abbott/AbbVie, 5,Amgen, 2,Bristol-Myers Squibb, 5,Janssen Inc., 5,Hoffmann-La Roche, Inc., 5,Janssen Inc., 2,Janssen Inc., 5,Merck Pharmaceuticals, 5,Merck Pharmaceuticals, 5,Pfizer Pharmaceuticals, 5,Pfizer Pharmaceuticals, 5; B. Haraoui, Abbott, Amgen, BMS, Janssen, Pfizer, Roche and UCB Pharma, 2,Abbott, Amgen, BMS, Janssen, Pfizer, Roche and UCB Pharma, 5,Abbott, Amgen, BMS, Janssen, Pfizer, Roche and UCB Pharma, 8; V. Bykerk, None.

To cite this abstract in AMA style:

Barra L, Pope JE, Hitchon C, Boire G, Lin D, Thorne JC, Tin D, Keystone EC, Haraoui B, Bykerk V. Cardiovascular Disease in a Large Incident Cohort of Early Inflammatory Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/cardiovascular-disease-in-a-large-incident-cohort-of-early-inflammatory-arthritis/. Accessed .

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