ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 841

Lipid Control and Cardiovascular Risk for Patients with Rheumatoid Arthritis Compared with Matched Non-Rheumatoid Arthritis Patients

J An1, E Alemao2, K Reynolds3, H Kawabata2, D H Solomon4, K P Liao4 and T C Cheetham3, 1Western University of Health Sciences, Pomona, CA, 2Bristol-Myers Squibb, Princeton, NJ, 3Kaiser Permanente Southern California, Pasadena, CA, 4Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Session Title: Rheumatoid Arthritis - Clinical Aspects I: Cardiovascular Disease Risk

Session Type: Abstract Submissions (ACR)

Background/Purpose: Lipid levels are known to be lower in patients with RA compared with the general population; however, differences in cardiovascular (CV) risk associated with lipid control between patients with RA and non-RA patients remain uncertain. The purpose of this study is to evaluate the association between low-density lipoprotein cholesterol (LDL) control and CV outcomes among RA and matched non-RA populations. Methods: Between 01/01/2007 and 12/31/2011, adult patients with RA were identified within Kaiser Permanente Southern California. Two age- and sex-matched cohorts were identified as non-RA: 1) 1:4 matched general population, and 2) 1:1 matched osteoarthritis (OA) population. Individuals were followed from their index date until the first CV outcome (myocardial infarction, angina, stroke, transient ischemic attack, intermittent claudication, heart failure or CV disease death), end of enrollment or death from other causes. Univariate and multivariate Cox proportional hazard analyses were conducted for patients treated for dyslipidemia who had ≥1 LDL measurement during the follow-up period. LDL measures closest to the end of follow-up were used to define LDL control (mg/dL) stratified by CV risk. Results: Cohort 1 consisted of 1522 patients with RA and 6511 matched patients from the general population; Cohort 2 had 1746 patients with RA and 2554 matched patients with OA. Median follow-up was 3.1 years for Cohort 1, and 4.0 years for Cohort 2. Mean (SD) age was 63.5 (10.2) years for both cohorts; there were 71.4% females in Cohort 1 and 75.8% in Cohort 2. In addition to dyslipidemia, 74.2% of patients with RA had hypertension, 40.9% had diabetes, 46.7% were obese, 10.5% were smokers, 41.3% had high CV risk, and 51.3% had medium CV risk. Traditional CV risk factors were higher in RA compared with general (Cohort 1) or OA populations (Cohort 2). Mean (SD) LDL levels (mg/dL) were 96.8 (32.7) for RA, 100.1 (35.1) for the general population, and 99.1 (34.3) for the OA population. The rate of LDL control was 78.7% for both the RA and general populations, and 80.0% for the OA population. Adjusting for age, sex, hypertension, antihypertensive medication use, smoking status, and diabetes, controlled LDL was associated with a 33% reduced CV risk compared with uncontrolled LDL in patients with RA (hazard ratio [HR] [95% CI] = 0.67 [0.46, 0.96] for Cohort 2). Controlled LDL was also associated with a reduced CV risk compared with uncontrolled LDL in the general population (HR = 0.72 [0.55, 0.95]). Similar HR results were found in the OA population; however, the association was not statistically significant (HR = 0.76 [0.53, 1.07]) (Table).

Table. Association between LDL Control and Cardiovascular Events for Patients with Treated Dyslipidemia
 Cohort Cohort 1 Cohort 2
RA population N=1522 RA population N=1746
RA patients HR (95% CI) p-value HR (95% CI) p-value
LDL control (vs no control)* 0.72 (0.49, 1.07) 0.104 0.70 (0.49, 1.00) 0.053
LDL control (vs no control)µ 0.68 (0.46, 1.02) 0.060 0.67 (0.46, 0.96) 0.028
General population N=6511 Osteoarthritis population N=2554
Non-RA patients HR (95% CI) p-value HR (95% CI) p-value
LDL control (vs no control)* 0.83 (0.63, 1.09) 0.179 0.93 (0.65, 1.31) 0.659
LDL control (vs no control)µ 0.72 (0.55, 0.95) 0.021 0.76 (0.53, 1.07) 0.118
* Results from univariate analyses µ Results from multivariate analyses adjusting for age, sex, hypertension, antihypertensive medication use, smoking, diabetes
  Conclusion: LDL control was associated with a reduced CV risk in the RA and matched general populations. These results suggest an important role for LDL control in preventing CV events among patients with RA as well as non-RA patients.  

Disclosure:

J. An,

BMS, Genentech, Merck ,

2;

E. Alemao,

Bristol-Myers Squibb,

1,

Bristol-Myers Squibb,

3;

K. Reynolds,
None;

H. Kawabata,

Bristol-Myers Squibb,

1,

Bristol-Myers Squibb,

3;

D. H. Solomon,
None;

K. P. Liao,
None;

T. C. Cheetham,

BMS, Gilead,

2.

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