Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Rheumatoid arthritis (RA) is a chronic inflammatory joint disease which is associated with an increased cardiovascular (CV) risk. It is still unknown to what extent this is due to CV risk factors or the underlying inflammatory process in RA. With the advent of effective anti-inflammatory and cardioprotective treatment, this riskmight be mitigated or even reduced. The present study compared changes in CV risk factors, RA-related factors and medication use over time in RA-patients who did and did not develop CV disease during follow-up.
Methods: Starting from 2000-2001, 10-year incidence rate of CV disease, CV risk factors, RA-related factors and medication use were assessed in a prospective cohort of 353 RA patients at baseline, at 3-years and at 10-years of follow-up. Associations between the changes in RA related factors and development of CV disease were assessed using generalized estimating equation (GEE) analyses, while changes in all variables were assessed with general linear models (GLM).
Results: After 10 years, there were 58 CV events over 2361 patient years of follow-up, incidence rate (IR) of 25.3/1.000 patientyears. This was similar to the IR between 3-years and 10-years of follow-up: 22.8/1.000 patientyears. GLM analyses showed that use of antihypertensives, statins, TNF inhibitors and general CV risk increased significantly over time, while RA related factors improved significantly. GEE analyses showed that increased use of TNF inhibitors was positively associated with less incident CV disease.
Conclusion: The risk of incident CV disease persists in patients with RA despite the advent of effective anti-inflammatory therapies and increased use of cardioprotective medication in recent years. Patients who used TNF inhibitors and, more indirectly, had a reduction in inflammation or disease activity, were less at risk of developing a CV disease. General CV risk and use of cardioprotective medications did not attenuate this association. A more aggressive cardioprotective and anti-inflammatory treatment of RA might mitigate the burden of CV disease in RA.
Table 1. Changes in CV risk factors and RA-related factors during follow-up
|
|
Baseline (n=353) |
Change 0-3 years (n=226) |
Change 3-10 years (n=164) |
|
Changes in CV-risk factors |
|
|
|
|
Total cholesterol, in mmol/L |
5.82 ± 1.11 |
-0.21 |
+0.05 |
|
LDL-cholesterol, in mmol/L |
3.73 ± 1.03 |
+0.37 * |
+0.07 |
|
HDL-cholesterol, in mmol/L |
1.48 ± 0.48 |
+0.17 * |
-0.07 |
|
Triglycerides, in mmol/L |
1.3 (1.0-1.8) |
0 |
0 |
|
Total-/HDL-cholesterol ratio |
4.32 ± 1.48 |
-0.63 * |
+0.10 |
|
Statins, % |
9 |
+3 * |
+5 * |
|
Systolic BP, mmHg |
141 ± 19 |
0 |
0 |
|
Diastolic BP, mmHg |
81 ± 8 |
0 |
+5 * |
|
Antihypertensives, % |
24 |
+4 |
+11 * |
|
Hypertension, % |
59 |
-6 * |
+3 |
|
DM, % |
5 |
0 |
+4 * |
|
Current smoking, % |
27 |
-5 |
-10 * |
|
Packyears |
18 (1-34) |
-1 |
+3 |
|
Body-mass index, kg/m2 |
26.7 ± 4.8 |
+0.4 * |
+0.2 * |
|
|
|
|
|
|
Markers for CV risk |
|
|
|
|
Intima-media thickness, mm |
0.815 ± 0.136 |
+0.030 |
-0.006 |
|
10-year CV risk (SCORE) |
5.0 (2.4-9.5) |
+0.5 |
+4.4 * |
|
|
|
|
|
|
RA-related factors |
|
|
|
|
ESR, mm/hour |
17 (9-31) |
-2 * |
-1 * |
|
CRP, mg/L |
7 (3-18) |
-2 * |
-2 * |
|
DAS-28 |
3.91 ± 1.38 |
-0.72 |
-0.05 |
|
DAS-remission (DAS28 <2.6) |
18 |
+6 |
-7 * |
|
HAQ |
0.75 (0.38-1.13) |
-0.12 * |
+0.02 |
|
Use of biologicals, % |
2 |
+9 * |
+14 * |
|
Use of MTX, % |
60 |
– |
-14 |
|
Use of prednisone, % |
15 |
– |
-2 |
|
Use of NSAIDs, % |
67 |
– |
-40 * |
* p < 0.05. Changes in CV- and RA-related factors are investigated by General Linear Models
Figures 1-4. Changes in use of biologicals and RA factors over time stratified for incident CV disease
Disclosure:
A. M. van Sijl,
None;
I. A. M. van den Oever,
None;
M. J. L. Peters,
None;
V. P. van Halm,
None;
A. E. Voskuyl,
None;
Y. M. Smulders,
None;
M. T. Nurmohamed,
None.
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