Background/Purpose:

We previously observed that incident RA patients have an increased risk of cardiovascular (CV) mortality relative to the general population in Ontario. Our aim was to evaluate the incidence and factors associated with major CV events subsequent to RA diagnosis.

Methods:

We studied incident RA patients within the population-based Ontario Rheumatoid Arthritis Database (ORAD). We analyzed all individuals who were diagnosed with RA after their 65th birthdate (ensuring comprehensive drug coverage) between 2000 and 2013. Our primary outcome was a composite measure which included acute myocardial infarction (AMI), stroke, congestive heart failure (CHF), revascularization with either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. All patients were followed from cohort entry until major CV event, censored on death, out-migration, or end of study period (Dec 2013), whichever occurred first. Factors associated with experiencing a major CV event during follow-up were analyzed using multivariable Cox regression to estimate hazard ratios (HRs), exploring the effects of baseline and time-varying medication exposures (including methotrexate, other DMARDs, anti-TNFs, COXIBS, NSAIDs, glucocorticosteroids, statins, antihypertensives), baseline comorbidities, time-varying development of extra-articular manifestations (as proxy for disease severity), healthcare use, and demographics (age, sex, rurality, socioeconomic status).

Results:

Among 23,994 incident RA patients, 67% were female. Patients had a high CV risk burden at the time of diagnosis (70% had pre-existing hypertension, 23% diabetes, 16% coronary artery disease, 3% previous AMI and 1% cerebrovascular disease). During 115,453 person-years of follow-up, 3,294 (14%) patients experienced a CV event for a crude rate of 28.5 events (95% CI 27.6,29.5) per 1,000 person-years [24.6 events (95% CI 23.5,25.7) among females and 37.4 events (95% CI 35.5,39.5) among males]. In our multivariable analysis, we did not observe clear associations with use of anti-rheumatic treatment during follow-up. Greater use of statins was associated with a lower CV event risk [HR 0.96 (95% CI 0.94,0.98)], whereas greater cumulative exposure to glucocorticosteroids was associated with an increased risk [HR 1.08 (95% CI 1.05,1.11)]. The strongest independent risk factors for a major CV event were pre-existing comorbidities at time of RA diagnosis, including coronary artery disease [HR 1.72 (95% CI 1.57,1.87)], prior AMI [HR 1.53 (95% CI 1.32,1.76)], renal disease [HR 1.43 (95% CI 1.20,1.70)], diabetes [HR 1.41 (95% CI 1.30,1.52)], cerebrovascular disease [HR 1.36 (95% CI 1.03,1.80)], and hypertension [HR 1.16 (95% CI 1.05,1.28)].

Conclusion:

Senior RA patients have a high CV risk burden at the time of RA diagnosis. Risk of experiencing a subsequent major CV event during follow-up was high. Pre-existing co-morbidities and glucocorticosteroids were positively associated with CV events, while statins were protective. This clearly highlights strategies to decrease CV events in RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/major-cardiovascular-events-among-an-inception-cohort-of-seniors-with-rheumatoid-arthritis/