Background/Purpose: We aimed to assess the 10-year CV event risk in patients with RA at the baseline and 1 year after the initiation of treatment with biologic DMARDs.

Methods: RA patients receiving biologic therapy were included . Participants were divided into 2 groups aged  21 to 49 years and 50 to 84 . The Framingham Risk Score (FRS) was used for the assessment of 10-year CVD risk. The presence of CV risk factors (fasting serum TC , HDL levels, history of HTN, DM and Dyslipidemia, and CV events) were ascertained by a medical records review and throughout a 1 year follow-up. Regression analyses of the relationship between lipids and inflammatory indices (CRP & DAS28) before and after treatment, as well as of biologic modifiers were performed.  

Results: The mean (SD) age of 215 patients (73.5% females) was 55.6 (12) years. The age at RA diagnosis was 41.6 (13.3) years with a mean (SD) duration of  symptoms at 14 (8.7) years. 7 cases with previously documented MI and 3 cases with TIA/Stroke were analysed. All patients had their CV events prior to the initiation of treatment with biologics with predicted 10-year CVD risk more than 30%. Smoking was documented in 19% of patients (61% females) at baseline and 1-year. TJC and SJC were significantly reduced after 12 months of treatment (12.5±8.6 vs. 9.0±7.5; p<0.001 and 4.3±3.8 vs. 1.9±2.4; p<0.001, respectively). The means of TC, HDL and the Atherogenic Index (AI) at the baseline and 12 months were compared: TC was not significantly increased from 3.1±2.8 to 3.3±2.6 (p=0.185); HDL increased from 0.7±0.7 to 0.9±0.7 (p=0.005); and AI was significantly reduced from 4.6±1.7 to 4.0±1.2 (p<0.001). CRP, ESR and DAS28 levels were  significantly reduced from  baseline (p=0.002; p<0.001 and p<0.001, respectively). Patients were grouped by their 10-year CVD risk level: Low Risk (<10%), Moderate Risk (10% to 19%), High Risk (20% and more). The trend analysis of 10-year CVD risk by gender showed that 7% of men in a 12-month period moved from the low/moderate risk to the high risk  (38.6% vs. 45.6%; p<0.001) while 4% of females significantly lowered their risk from the high to the moderate/low (11.4% vs. 7.6%; p<0.001). The analysis of relationship between lipids and inflammation indices as well as biologics did not show significance at the baseline and 1 year follow-up.

Conclusion: Our results showed a trend in reducing a 10-year CV event risk over 12-month of treatment with biologic disease modifiers. No serious cardiovascular events were observed during the study period. This improvement was influenced by many factors such as lipid-lowering treatment (30.7% of patients) and proper control of blood pressure and plasma glucose level (28.4% and 11.6% of patients, respectively). Females appeared to be more successful in reducing the CVD risk. Biologic DMARDs effectively decreased inflammation and possibly played a pivotal role in reducing the risk for CV event in patients with chronic RA. 

 RA Characteristics and lipid levels at baseline and 12-month

RA Characteristics	Baseline, mean (SD)	1-year F-Up, mean (SD)	P
Total Joint Count (TJC)	12.47 (8.550	8.97 (7.52)	<0.001
Swollen Joint Count (SJC)	4.33 (3.77)	1.94 (2.43)	<0.001
C-Reactive Protein (CRP), mg/l	16.24 (29.73)	9.92 (15.81)	0.002
ESR, mm/h	30.67 (23.20)	22.86 (20.77)	<0.001
DAS28 score	3.95 (1.34)	3.39 (1.25)	<0.001
CDAI score	17.44 (9.90)	13.00 (10.00)	<0.001
HAQ score	1.18 (0.73)	1.08 (0.75)	0.007
Total Cholesterol, mmol/l	3.10 (2.80)	3.30 (2.62)	0.185
HDL Cholesterol, mmol/l	0.73 (0.70)	0.86 (0.71)	0.005
Atherogenic Index (TC/HDL)	4.64 (1.68)	3.99 (1.18)	<0.001

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-risk-assessment-in-rheumatoid-arthritis-ra-patients-treated-by-biologic-response-modifiers/