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Abstract Number: 1390

Heterogeneity in Cardiovascular Risk Factors, Event Rates and RA Disease Characteristics Among Patients with Rheumatoid Arthritis Across 10 Countries – Implications for CV Risk Assessment

Atacc-RA Collaborative Group, Division of Rheumatology, Mayo Clinic, Rochester, MN; Diakonhjemmet hospital, Oslo, Norway; Dudley Group NHS Foundation Trust, West Midlands, United Kingdom; Radboud University Medical Center, Nijmegen, Netherlands; University of Umeå, Umeå, Sweden; University of Athens, Athens, Greece; Harbor UCLA Medical Center, Torrance, CA; Harvard Medical School Brigham and Women's Hospital, Boston, MA; Hospital Universitario Marques de Valdecilla, Santander, Spain; School of Physiology, Faculty of Health Sciences, Witwatersrand University, Johannesburg, South Africa; University of Manitoba, Winnipeg, MB, Canada; Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubir, México City, Mexico; Hospital Medisch Spectrum Twente, Enschede, Netherlands

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Cardiovascular disease, rheumatoid arthritis (RA) and risk assessment

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Session Information

Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Comorbidities, Treatment Outcomes and Mortality

Session Type: Abstract Submissions (ACR)

Background/Purpose

Patients with rheumatoid arthritis (RA) have an increased risk of cardiovascular disease (CVD). CVD risk scores for the general population do not accurately predict CVD events in RA. Heterogeneity of traditional CV risk factors and RA characteristics across various countries may be associated with varying impacts on CVD events. We compared the impact of traditional CV risk factors and RA characteristics on CVD outcomes in RA patients from 10 countries.

Methods

RA cohorts from 13 rheumatology centers in UK, Norway, Netherlands, US, Sweden, Greece, South Africa, Spain, Canada and Mexico were compared. Data on CV risk factors and RA characteristics were collected at baseline for each cohort; CVD outcomes were collected prospectively using standardized definitions.  Cox models with random effects for center were used to compare the impact of CV risk factors and RA characteristics on CVD events. Traditional CV risk factor effects were adjusted for age and sex; RA characteristic effects were adjusted for age, sex and CV risk factors.

Results

5685 RA patients without prior CVD were included (mean age: 55 [SD: 14] years, 76% female).  During a mean follow-up of 6.1 years (31155 person years), 476 patients developed CVD events. RA duration varied by center: 4 with early RA (<1 year), 7 established (mean 9-13 years) RA and 2 with both. Mean age varied from 37 to 61 years (younger in the early RA cohorts - p<0.001); females varied from 66% to 90% (p<0.001). 2 cohorts consisted of Hispanics, the rest Caucasians. CVD event rates varied across countries (range of 5 year CVD event rate: 0.8 – 7.5%) with the lowest observed in Norway and UK and the highest in South Africa, Netherlands, US-Mayo and Sweden.  Age effects were fairly consistent (hazard ratios [HR] ranged from 1.6-1.8 per 10 year increase in age), but male sex varied from no effect to a doubled effect (HR=1.0-2.3). Varied effects were also seen for current smoking (HR=1.1-2.1), hypertension (HR=0.6-2.0), total cholesterol: high-density lipoprotein ratio (HR=0.9-1.2) and diabetes mellitus (HR=0.7-2.8).  Effects were also varied for RA characteristics, including rheumatoid factor and/or anti-citrullinated protein antibody seropositivity (HR=0.7-1.4), disease activity score [DAS28] (HR=0.9-1.2) and RA disease duration (HR=0.7-1.1 per 10 years).

Conclusion

Major heterogeneity exists in CVD event rates and in the effects of traditional CV risk factors and RA characteristics on CVD outcomes among patients with RA across different countries. Generation of a CVD risk score that will be widely applicable for patients with RA must address this inherent heterogeneity. Efforts are underway to do this.

Acknowledgements: The ATACC-RA international collaborative group: Sherine Gabriel, Cynthia Crowson, George Kitas, Karen Douglas, Aamer Sandoo, Anne Grete Semb, Silvia Rollefstad, Eirik Ikdahl, Piet Van Riel, Elke Arts, Jaap Fransen, Solbritt Rantapää-Dahlqvist, Solveig Wållberg-Jonsson, Lena Innala,George Karpouzas, Petros Sfikakis, Evi Zampeli, Patrick Dessein, Linda Tsang, Miguel A. Gonzalez-Gay, Alfonso Corrales, Hani El-Gabalawy, Carol Hitchon, Virginia Pascual Ramos, Irazú Contreras Yáñez, Daniel Solomon, Katherine Liao, Mart van de Laar, Harald Vonkeman, Inger Meek.


Disclosure:

A. R. Collaborative Group,
None;

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/heterogeneity-in-cardiovascular-risk-factors-event-rates-and-ra-disease-characteristics-among-patients-with-rheumatoid-arthritis-across-10-countries-implications-for-cv-risk-assessment/

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