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Abstract Number: 392

Prevalence Of Cardiovascular Risk Factors and Cardiovascular Disease In Rheumatoid Arthritis Patients Across International Regions: A Comparison Of The Corrona International and Corrona United States Registries

Dimitrios A. Pappas1, Kathy Lampl2, Joel M. Kremer3, Sebastião C. Radominski4, Janos Gal5, Fredrik Nyberg6, Anand N. Malaviya7, Aimée Whitworth8, Oscar Luis Rillo9, Allan Gibofsky10, Tatiana Popkova11, Meilien Ho12, Ieda Laurindo13, George W. Reed8, Eduardo Mario Kerzberg14, Laura Horne15, Roman Záhora16, Katherine C. Saunders17, Bernado Pons-Estel18, Alina U. Onofrei19 and Jeffrey D. Greenberg20, 1Columbia University, New York, NY, 2AstraZeneca R&D Wilmington, Wilmington, DE, 3Center for Rheumatology, Albany Medical College, Albany, NY, 4Universidade Federal do Paraná, Curitiba, Brazil, 5Rheumatology, County Hospital, Kecskemet, Hungary, 6AstraZeneca R&D, Mölndal, Sweden, 7Rheumatology, Consultant Rheumatologist, ISIC Superspeciality Hospital, New Delhi-11007-, India, 8CORRONA, Inc., Southborough, MA, 9Hospital Tornú, Capital Federal, Argentina, 10Medicine and Public Health, Hospital for Special Surgery, New York, NY, 11Research Institute of Rheumatology -Russian Academy of Medical Science, Moscow, Russia, 12AstraZeneca R&D Alderley Park, Macclesfield, United Kingdom, 13Rheumatology, Universidade de São Paulo, São Paulo, Brazil, 14Rheumatology, J. M. Ramos Mejía Hospital, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina, 15AstraZeneca, Wilmington, DE, 16Revmatologická ambulance, Terezin, Czech Republic, 17Corrona, LLC., Southborough, MA, 18Hospital Provincial de Rosario, Rosario, Argentina, 19University of Massachusetts Medical School, Worcester, MA, 20Rheumatology, NYU Hospital for Joint Diseases, New York, NY

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Cardiovascular disease, Disease Activity, longitudinal studies, rheumatoid arthritis (RA) and risk

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Session Information

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

Session Type: Abstract Submissions (ACR)

Background/Purpose: Cardiovascular disease (CVD) is a major comorbidity in patients (pts) with rheumatoid arthritis (RA). We explored variations in the prevalence of cardiovascular (CV) risk factors and CVD among patients (pts) in different international regions using data in CORRONA International (C.Intl) and CORRONA US (C.USA) registries.

 

Methods: The C.Intl registry, launched in September 2011, is a multi-center, observational registry. Adult RA pts have been enrolled from 83 rheumatology practices in 10 countries in 3 regions [Latin America: Mexico, Brazil, Argentina; Eastern Europe: Poland, Czech Republic, Hungary, Romania, Russia, Ukraine; Asia: India].  The only exclusion criteria are functional class IV and age >85 years old.

The C.USA registry was launched in 2001 and enrolls pts from 111 rheumatology practices across the United States. There are no exclusion criteria.

Both registries collect data in a similar manner on demographics, lifestyle characteristics, anthropometry, medication exposures, adverse events and comorbidities from rheumatologists and RA pts at regular clinical encounters.

We present cross-sectional baseline descriptive data for demographic and disease characteristics for the C.Intl regions. We compare this information with cross-sectional data from the most recent visit of C.USA-enrolled pts excluding those with functional class IV and >85 years of age. Prevalence for CV risk factors and CVD are presented crude for C.USA and age/gender-standardized to the C.USA age/gender distribution (age categories <50, 50-<60, 60-<70, ≥70 years) for C.Intl regions. No formal statistical testing was conducted.

 

Results: As of March 4 2013, 5696 pts had been enrolled in C.Intl and 20291 pts with functional class While there are cross-sectional differences across all regions, in general, the greatest differences are between the US and C.Intl overall.  There is a higher percentage of male pts in C.USA, disease duration is longer, and pts tend to have lower disease activity, yet are more likely to receive a biologic (Table 1).

After adjusting for age and gender differences by standardization, enrolled pts in India have the lowest BMI, are more rarely smokers and have a low prevalence of hyperlipidemia and CVD compared to other C.Intl regions and C.USA (Table 1).  C.USA participants have the highest BMI. Participants from Eastern Europe suffer more frequently from hypertension and hyperlipidemia and have the highest prevalence of all manifestations of CVD (Table 1).

 

Conclusion: Data from the C.Intl and C.USA registries reveal variations in disease characteristics, as well as prevalence of CV risk factors and CVD across different regions. Observed differences may be influenced by differences in the composition and treatment of pts populations and should be considered in analyses and evaluation of pts from different geographic origins.

 

Table 1*. Demographic and disease characteristics, CV risk factors and CVD in RA patients from international regions and from the US

 

CORRONA International – regions

 CORRONA US

 

Latin America

Eastern Europe

Asia

NUMBER OF PATIENTS (N)

2030

2517

1149

20291

Demographic and disease characteristics

Females (n,%)

1759 (86.7%)

2099 (83.4%)

982 (85.5%)

15358 (76.6%)

Age / years (mean, SD)

54.2 (12.9)

57.1 (12.2)

47.6 (11.9)

60.3 (12.6)

Disease duration / years (mean, SD)

9.9 (8.7)

9.1 (8.6)

6.3 (5.8)

12 (10.1)

Anti-CCP or RF positive (%)

1695 (83.5%)

1922 (76.4%)

750 (65.4%)

9867 (76%)

CDAI (mean, SD)

14.6 (13.3)

19.1 (14.3)

15.3 (11.8)

10.4 (11.2)

Current RA medications

 

 

 

 

On biologic (n,%)

400 (19.7%)

323 (12.8%)

6 (0.5%)

10516 (51.8%)

On DMARD(s) but not on biologics (n,%)

1374 (67.7%)

1782 (70.8%)

1026 (89.3%)

8430 (41.5%)

Corticosteroids (n,%)

842 (41.5%)

690 (27.4%)

304 (26.5%)

4635 (22.8%)

 Prevalence of CV risk factors (age/gender standardized)

Family history of early AMI (<60 years) (n,%)

255 (12.5%)

270 (10.2%)

84 (6.8%)

677 (3.3%)

Family history of early stroke (<60 years) (n,%)

115 (5.4%)

194 (7.2%)

21 (2.1%)

259 (1.3%)

BMI (mean, SD)

27.3 (7.6)

27.4 (6)

24.2 (5.3)

29.4 (7)

Current smoker (n,%)

327 (15.9%)

339 (12.9%)

23 (2.7%)

3015 (15%)

Hypertension (n,%)

655 (39.4%)

1378 (58.1%)

186 (31.7%)

6359 (31.4%)

Hyperlipidemia (n,%)

317 (18.6%)

677 (28%)

33 (5.3%)

1463 (7.2%)

Prevalence of CVD  (age/ gender standardized)

Congestive Heart Failure (n,%)

19 (1.3%)

48 (2.1%)

0 (0%)

44 (1.1%)

Coronary artery disease  (n,%)

21 (1.9%)

282 (12.9%)

12 (1.8%)

920 (4.5%)

AMI  (n,%)

20 (1.6%)

69 (3.6%)

6 (2.2%)

560 (2.8%)

Unstable angina  (n,%)

1 (0.1%)

20 (0.8%)

2 (0.1%)

78 (0.4%)

Peripheral arterial disease (n,%)

4 (0.3%)

26 (1.2%)

0 (0%)

50 (0.2%)

Stroke (n,%)

15 (0.9%)

44 (2.2%)

1 (0.9%)

407 (2%)

TIA  (n,%)

9 (0.8%)

38 (1.5%)

2 (0.4%)

175 (0.9%)

* all data are from baseline visits for CORRONA International, and cross-sectional data from the most recent visit of pts enrolled in CORRONA US.

ABBREVIATIONS CCP: Cyclic Citrullinated Peptide; CDAI: Clinical Disease Activity Index; DMARDs: Disease Modifying Anti-Rheumatic Drugs; AMI: Acute Myocardial Infarction; BMI: Body Mass Index; TIA: Transient Ischemic Attack

 


Disclosure:

D. A. Pappas,

Corrona, Inc.,

3,

Novartis Pharmaceutical Corporation,

9;

K. Lampl,

AstraZeneca,

1,

AstraZeneca,

3;

J. M. Kremer,

Corrona, Inc,

1,

Corrona Inc.,

3;

S. C. Radominski,

Pfizer,BMS,Astra Zeneca, Amgen, Sanofi, Novartis, Celltrion, Roche,

2,

Pfizer,BMS,Astra Zeneca,

5,

Pfizer,BMS,Astra Zeneca,Janssen,Sanofi, GSK,

8,

-Universidade Federal do Parana- Curitiba- Brzazil,

3;

J. Gal,
None;

F. Nyberg,

AstraZeneca,

1,

AstraZeneca,

3;

A. N. Malaviya,

Member Advisory Board Janssen Pharma, Roche Pharma, Sanoffi Pharma,part time consultant rheumatologist at ISIC Hospital,

5;

A. Whitworth,

CORRONA, Inc.,

3;

O. L. Rillo,
None;

A. Gibofsky,

AstraZeneca,

5;

T. Popkova,

GlaxoSmithKline, MSD, AstraZeneca,

8;

M. Ho,

AstraZeneca,

3;

I. Laurindo,

Abbott,Astra-Zenica, Bristol,Janssen,Pfizer,

5,

Abbott,Astra-Zenica, Bristol,Janssen,Pfizer, Roche,

8;

G. W. Reed,

Corrona Inc,

3;

E. M. Kerzberg,
None;

L. Horne,

AstraZeneca,

3,

AstraZeneca,

1;

R. Záhora,
None;

K. C. Saunders,

CORRONA Inc.,

3;

B. Pons-Estel,

Abbott Laboratories,

2;

A. U. Onofrei,

UMASS Medical School,

3;

J. D. Greenberg,

Corrona, Inc.,

1,

Astra Zeneca, CORRONA, Novartis and Pfizer,

5.

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