Background/Purpose: RA patients are known to be at increased risk of vascular morbidity and mortality, although conflicting reports exist for incident RA patients. Our aim was to evaluate the risk of cardiovascular and cerebrovascular disease (CVD) mortality in seniors with incident RA in Ontario, Canada.

Methods: We undertook a population-based cohort study of incident RA patients aged 66 years or older (ensuring comprehensive drug coverage) from 2000 to 2013. We identified four non-RA general population comparators for each RA patient, matched on age, sex and region of residence. All patients were followed until death (primary cause due to CVD ascertained from vital statistics, with censorship for deaths due to competing cause), out-migration, or end of study period (Dec 2013). Crude and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox models, controlling for time-varying drugs (statins, antihypertensives, NSAIDs, COX-II inhibitors), baseline comorbidities, healthcare use, and socioeconomic status.

Results: 28,322 RA patients and 113,288 comparators were followed for 142,534 and 502,823 person years, respectively. During a median follow-up of 4 years, 1,947 (6.9%) RA patients and 6,340 (5.6%) comparators died due to CVD, corresponding to CVD mortality rates of 13.7 (95% CI 13.1-14.3) and 12.6 (95% CI 12.3-12.9) per 1000 patient-years, respectively. Risk of vascular mortality was not greatly increased in incident RA relative to age/sex/area-matched comparators (unadjusted HR, 1.02; 95% CI 0.96-1.09; adjusted HR, 0.98; 95% CI 0.91-1.05). Risk for CVD mortality was lower in patients using statins (HR, 0.60; 95% CI 0.56-0.64), COX-II inhibitors (HR, 0.68; 95% CI 0.59-0.78) and NSAIDs (HR, 0.74; 95% CI 0.62-0.90), and in those with a prior joint replacement (HR, 0.80; 95% CI 0.72-0.90); and greater with pre-existing comorbidities (coronary artery disease, hypertension, COPD/asthma, renal failure, cerebrovascular disease, acute myocardial infarction, diabetes), use of antihypertensive agents (HR, 1.17; 95% CI 1.09-1.25), and being in a lower socioeconomic status (HR, 1.32; 95% CI 1.20-1.46)

Conclusion: In these analyses, seniors with incident RA were not shown to have an increased risk of vascular mortality, although longer follow-up is warranted. Use of statins, COX-II inhibitors, and NSAIDs was associated with a decreased risk for vascular mortality, although residual confounding cannot be ruled out.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-vascular-mortality-in-seniors-with-new-onset-rheumatoid-arthritis/