Background/Purpose:

The prevalence of cardiovascular disease (CVD) in chronic inflammatory rheumatic diseases (CIRD) is higher than in the general population. Recent studies have emphasized that tight control of the disease leads to a reduction in the rate of CVD in patients with rheumatic diseases. However, the prevalence of CVD in patients with CIRD and low disease activity is not well established. Thus, the aim f this study was to establish the cardiovascular (CV) morbidity and associated risk factors for CV disease (CVD) in Spanish patients with chronic inflammatory rheumatic diseases (CIRD) with low disease activity and unexposed individuals attending rheumatology clinics.

Methods:

Analysis of data from the baseline visit of a 10-year prospective study (CARdiovascular in rheuMAtology-CARMA-project) that includes a cohort of patients with CIRD [rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA)] and another cohort of matched individuals without CIRD attending outpatient rheumatology clinics from sixty-six hospitals in Spain. Prevalence of CV morbidity, CV risk factors and systematic coronary risk evaluation (SCORE) assessment were analyzed.

Results:

2,234 patients (775 RA, 738 AS and 721 PsA) and 677 unexposed subjects were included.
Patients had low disease activity at the time of recruitment. PsA patients had more commonly classic CV risk factors and metabolic syndrome features than did the remaining individuals.
Prevalence of CVD was higher in RA (10.5%) than in AS (7.6%), PsA (7.2%) and unexposed individuals (6.4%). A multivariate analysis adjusted for the presence of classic CV risk factors and disease duration revealed a positive trend for CVD in RA (OR=1.58; 95%CI=0.90-2.76; p=0.10) and AS (OR=1.77; 95%CI=0.96-3.27; p=0.07). Disease duration in all CIRD groups and functional capacity (HAQ) in RA were associated with an increased risk of CVD (OR=2.15; 95%CI=1.29-3.56; p=0.003). Most patients had a moderate CV risk according to the SCORE charts.

Conclusion:

Despite recent advances in the management of CIRD, incidence of CVD remains increased in Spanish subjects with CIRD attending outpatient rheumatology clinics. It is of particular relevance that almost half of them were receiving biological therapy and most patients had low disease activity at the time of assessment.