Incidence of First Cardiovascular Event in Spanish Patients with Chronic Inflammatory Rheumatic Diseases: Prospective Data from an Observational Multicentric Study

Maria Auxiliadora Martin¹, Santos Castañeda², Carlos González-Juanatey³, Fernando Sánchez-Alonso⁴, María Carmen García-Gómez⁵, R López-González⁶, Jesus Babio⁷, Antonio Juan-Mas⁸, María P Moreno-Gil⁹, Olga Sanchez-González¹⁰, Montserrat Romera¹¹, Jose A Pinto-Tasende¹², Jose A Piqueras¹³, Dolores Fábregas¹⁴, Javier Llorca¹⁵ and Miguel Angel González-Gay¹⁶, ¹Research Unit of Spanish Society of Rheumatology,, Madrid, Spain, ²Hospital Universitario La Princesa, IIS-Princesa, Madrid, Spain, ³Cardiology Division, Hospital Xeral-Calde, Lugo, Spain, ⁴Unidad de Investigación, Spanish Society of Rheumatology, Madrid, Spain, ⁵Rheumatology Division, Consorci Sanitari de Terrassa, Terrassa (Barcelona), Spain, ⁶Rheumatology, Complejo Hospitalario de Zamora. Spain, Zamora, Spain, ⁷Rhaumatology, H General de Cabueñes, Gijon, Spain, ⁸Division of Rheumatology, Hospital Son Llatzer, Palma de Mallorca, Spain, Spain, ⁹Division of Rheumatology, Hospital San Pedro de Alcántara, Cáceres, Spain, ¹⁰Division of Rheumatology, Hospital del Sureste, Madrid, Spain, ¹¹Division of Rheumatology, Hospital de Bellvitge, Barcelona, Spain, ¹²Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain, ¹³Division of Rheumatology, Hospital Universitario de Guadalajara, Guadalajara, Spain, ¹⁴Division of Rheumatology, Hospital de Barbastro, Huesca, Spain, ¹⁵Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, Santander, Spain, Santander, Spain, ¹⁶School of Medicine, University of Cantabria, Santander, Spain, Santander, Spain

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Ankylosing spondylitis (AS), Cardiovascular disease, Comorbidity, psoriatic arthritis and rheumatoid arthritis (RA)

Session Information

Date: Sunday, October 21, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster I: Comorbidities

Session Type: ACR Poster Session A

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

Background/Purpose: To determine the incidence and risk factors implicated in the development of first cardiovascular event (CVE) in patients with chronic inflammatory rheumatic diseases (CIRD) attending rheumatology clinics after 2.5 years of follow-up.

Methods: Analysis of data after 2.5 years of follow-up in an observational 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 67 hospitals in Spain. The cumulative incidence per 1000 patients and the incidence density per 1000 patient-months of non-fatal CVE were estimated in both cohorts at 2.5 years from the start of the project. Weibull proportional hazard model was used to calculate the Hazard Ratio (HR) and 95% confidence interval (95% CI) of the risk factors involved in the development of CVD events. Losses to follow-up and their causes were also analyzed.

Results: The total number patient who completed the follow-up visit at 2.5 years was 2,598 (89.2% of those who started the study). Seven patients had died due to CVE and 23 because of non-CVE. The higher number of losses to follow-up was found in the control group (15.81%), because many of them were not periodically follow-up at the outpatient clinics. Cardiovascular cumulative incidence in patients with CIRD 15.30 cases per 1000 patients (95% CI: 12.93-17.67), being higher in AS patients 22.03 (95% CI: 11.01-33.04). The higher risk of developing a first CVE during the 2.5 years of follow-up was in patients with AS (HR: 4.11, 95% CI: 1.07-15.79; p: 0.04), those with older age (HR:1.09; 95% CI: 1.05-1.13, p <0.001), higher systolic blood pressure (HR: 1.02; 95% CI: 1.00-1.04, p = 0, 01) and longer duration of the rheumatic disease (HR: 1.07; 95% CI: 1.03-1.12), p <0.01). In contrast, female gender was a protective factor (HR: 0.43; 95% CI: 0.18-1.00, p = 0.05).

Conclusion: Patients with AS prospectively followed-up at rheumatology outpatient clinics show higher risk of developing a first CVE than those with RA or PsA. Besides traditional CVD risk factors a longer time course of the disease is a risk factor for the development of CVD in patients with CIRD.

Acknowledgements: This project has been supported by an unrestricted grant from Abbvie, Spain. The design, analysis, interpretation of results and preparation of the manuscript has been done independently of Abbvie.

Disclosure: M. A. Martin, None; S. Castañeda, None; C. González-Juanatey, None; F. Sánchez-Alonso, None; M. C. García-Gómez, None; R. López-González, None; J. Babio, None; A. Juan-Mas, None; M. P. Moreno-Gil, None; O. Sanchez-González, None; M. Romera, None; J. A. Pinto-Tasende, None; J. A. Piqueras, None; D. Fábregas, None; J. Llorca, None; M. A. González-Gay, None.

To cite this abstract in AMA style:

Martin MA, Castañeda S, González-Juanatey C, Sánchez-Alonso F, García-Gómez MC, López-González R, Babio J, Juan-Mas A, Moreno-Gil MP, Sanchez-González O, Romera M, Pinto-Tasende JA, Piqueras JA, Fábregas D, Llorca J, González-Gay MA. Incidence of First Cardiovascular Event in Spanish Patients with Chronic Inflammatory Rheumatic Diseases: Prospective Data from an Observational Multicentric Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/incidence-of-first-cardiovascular-event-in-spanish-patients-with-chronic-inflammatory-rheumatic-diseases-prospective-data-from-an-observational-multicentric-study/. Accessed .

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