Background/Purpose:  Patients with rheumatoid arthritis (RA) have a higher risk of cardiovascular disease (CVD) and premature mortality, compared to the general population. Inflammatory burden and conventional cardiovascular (CV) risk factors contribute to the development of carotid atherosclerosis in patients with RA. We evaluated the effects of RA on the occurrence of CVD and mortality in a prospective study of an Asian population.

Methods:  A total of 369 patients with RA and 160 healthy controls were followed up for 5 years or until deaths in a prospective KARRA cohort study (412 patients and 221 controls at baseline). To detect the presence and progression of carotid atherosclerosis, we performed carotid ultrasound at baseline and 5-year. We analyzed the incidence of CVD, conventional CV risk factors, RA disease activity and severity markers, medication histories, mortality rate, and causes of death.

Results:  During 5-year follow-up period, the mortality rate was 5.8% (24/412) in RA patients and 0% in healthy controls (p<0.001), while the incidence of CVD were 6.1% (25/412) in RA patients and 0.5% (1/221) in healthy controls (p<0.001). Among CVD in RA patients, cerebrovascular accident (CVA) and cardiovascular event (CVE) were 8 (32%) and 17 (68%) events, respectively. Major causes of death included infection (11/24, 45.8%), CVD (6/24, 25%), and others (7/24, 29.2%). The mean age, presence and number of carotid plaques, functional class, modified Korean version of the HAQ (mKHAQ), tender joint count (TJC), swollen joint count (SJC), ESR and CRP, and conventional CV risk factors at baseline were significantly associated with mortality among RA patients. Multivariate logistic regression analysis showed that the presence of carotid plaque (OR 5.32 [95% CI 1.09-25.99; P = 0.039]), mKHAQ (OR 1.07 [95% CI 1.02-1.13; P = 0.007]), and ESR (OR 1.04 [95% CI 1.02-1.06; P < 0.001]) at baseline were independent risk factor for mortality of RA patients. In contrast, factors associated with new-onset CVD included the mean age, presence and number of carotid plaques, peak CRP, and conventional CV risk factors at baseline. Carotid plaque (OR 7.86 [95% CI 2.14-28.83; P = 0.002]) and two or more CV risk factors (OR 4.77 [95% CI 1.07-21.23; P = 0.040]) at baseline were independent predictive factors for new-onset CVD of RA patients in a multivariate logistic regression analysis.

Conclusion:  This prospective study shows that a common risk factor for CVD and mortality is carotid plaque which is determined by disease activity and CV risk factors. While disease activity of RA is a critical determinant for the mortality, the development of CVD depends on conventional CV risk factors.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-diseases-and-mortality-are-independently-influenced-by-carotid-plaque-presence-in-rheumatoid-arthritis-the-5-year-prospective-study/