Outcomes Of Patients With Rheumatoid Arthritis and Comorbid Hyperlipidemia

L Rosenblatt¹, JR Curtis², G Yang¹ and T Hebden³, ¹Bristol-Myers Squibb, Plainsboro, NJ, ²University of Alabama at Birmingham, Birmingham, AL, ³Formerly of Bristol-Myers Squibb, Plainsboro, NJ

Meeting: ACR/ARHP Annual Meeting 2013

Keywords: Cardiovascular disease and rheumatoid arthritis (RA)

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects I: Comorbidities in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose: Patients (pts) with RA have an increased prevalence of cardiovascular disease (CVD). Whether due to comorbidity or related to RA medications, many pts with RA have hyperlipidemia, a risk factor for CVD. Using data from a real-world setting we determined the overall and sex-specific risk of cardiovascular (CV) events in pts with RA, with or without comorbid hyperlipidemia, relative to those in a non-RA cohort. Methods: This retrospective cohort study using claims data from a US commercial health plan (2005–2011) included pts with ≥2 physician diagnoses of RA (ICD-9: 714.0, 714.2) and a non-RA cohort, matched 3:1 with the RA cohort on demographics (age, gender, region, index year). Follow-up began at the index date, 1 year after initiation of full coverage with medical and pharmacy benefits, and lasted until the first CV event, end of enrollment, or end of data availability. Incidence of the first hospitalized CV event (composite of myocardial infarction and ischemic stroke) or percutaneous coronary intervention/coronary artery bypass graft in the post-index period was determined for each cohort and stratified by sex and the presence of hyperlipidemia (defined by the presence of a ICD-9. 272.xx diagnosis claim or antihyperlipidemic agent drug claim during the pre-index period). Cox proportional hazards regression model determined the hazard ratio (HR) for CV events, using the presence of RA as the independent variable, controlling for other baseline covariates (age, sex, hyperlipidemia, diabetes, and hypertension). Results: The RA cohort consisted of 51,130 pts who were matched with 154,292 non-RA pts (37.9% and 38.7% with hyperlipidemia during baseline, respectively). The incidence of CV events per 1000 person-years was 10.19 for the RA cohort and 6.41 for the non-RA cohort (crude rate ratio [RR]=1.59). Within the RA cohort, incidence was 15.54 for pts with hyperlipidemia and 7.05 for pts without hyperlipidemia (crude RR=2.21); in the non-RA cohort, incidence was 10.55 and 3.82 for those with and without hyperlipidemia, respectively (crude RR=2.76). When controlling for covariates, the HR of CV events for pts with RA was 1.68 (95% CI: 1.50, 1.87) relative to non-RA pts. Among covariates, presence of hyperlipidemia conferred a significant risk of CV events (p<0.0001); the interaction between RA and hyperlipidemia was not significant (p=0.13). Sex-specific RRs and risk differences are shown.

Cohort	Hyperlipidemia (Yes/No)	Sex	CVD incidence rate (/1000 person-years)	Crude RR (with/without hyperlipidemia)	Crude rate difference (with – without hyperlipidemia)
RA	Yes	M	23.25	1.81	10.4
	No	M	12.85
	Yes	F	12.32	2.21	6.74
	No	F	5.58
Non-RA	Yes	M	14.74	2.23	8.13
	No	M	6.61
	Yes	F	8.66	2.76	5.52
	No	F	3.14

Conclusion: This real-world analysis demonstrates that pts with RA have an increased risk of CV events and, as seen with the non-RA cohort, CV event rates are incrementally higher for those pts with hyperlipidemia. Therefore, mitigating the increased CV risk associated with hyperlipidemia and optimizing lipid levels are key treatment strategies for pts with RA.

Disclosure:

L. Rosenblatt,

Bristol-Myers Squibb,

J. Curtis,

Roche/Genentech, UCB, Janssen, CORRONA, Amgen, Pfizer, BMS, Crescendo, AbbVie,

G. Yang,

Bristol-Myers Squibb,

T. Hebden,

Bristol-Myers Squibb,

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