Explaining the cardiovascular risk associated with rheumatoid arthritis: traditional risk factors versus markers of rheumatoid arthritis severity

• Published in: Annals of the rheumatic diseases Vol. 69; no. 11; pp. 1920 - 1925
• Main Authors: Solomon, Daniel H, Kremer, Joel, Curtis, Jeffrey R, Hochberg, Marc C, Reed, George, Tsao, Peter, Farkouh, Michael E, Setoguchi, Soko, Greenberg, Jeffrey D
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.11.2010; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Age Factors; Aged; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - epidemiology; Biological and medical sciences; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Diseases of the osteoarticular system; Epidemiologic Methods; Female; Health risk assessment; Heart attacks; Humans; Inflammatory joint diseases; Male; Medical sciences; Middle Aged; Rheumatoid arthritis; Sex Factors; Studies; United States - epidemiology; United States; Immunopathology; Rheumatoid factor; Chronic; Rheumatoid arthritis; Diseases of the osteoarticular system; Risk factor; Rheumatology; Cardiovascular risk; Autoimmune disease; Cardiovascular disease; Inflammatory joint disease; Comparative study
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2009.122226

Background Cardiovascular (CV) disease has a major impact on patients with rheumatoid arthritis (RA), however, the relative contributions of traditional CV risk factors and markers of RA severity are unclear. The authors examined the relative importance of traditional CV risk factors and RA markers in predicting CV events. Methods A prospective longitudinal cohort study was conducted in the setting of the CORRONA registry in the USA. Baseline data from subjects with RA enrolled in the CORRONA registry were examined to determine predictors of CV outcomes, including myocardial infarction, stroke or transient ischemic attack. Possible predictors were of two types: traditional CV risk factors and markers of RA severity. The discriminatory value of these variables was assessed by calculating the area under the receiver operating characteristic curve (c-statistic) in logistic regression. The authors then assessed the incidence rate for CV events among subjects with an increasing number of traditional CV risk factors and/or RA severity markers. Results The cohort consisted of 10 156 patients with RA followed for a median of 22 months. The authors observed 76 primary CV events during follow-up for a composite event rate of 3.98 (95% CI 3.08 to 4.88) per 1000 patient-years. The c-statistic improved from 0.57 for models with only CV risk factors to 0.67 for models with CV risk factors plus age and gender. The c-statistic improved further to 0.71 when markers of RA severity were also added. The incidence rate for CV events was 0 (95% CI 0 to 5.98) for persons without any CV risk factors or markers of RA severity, while in the group with two or more CV risk factors and three or more markers of RA severity the incidence was 7.47 (95% CI 4.21 to 10.73) per 1000 person-years. Conclusions Traditional CV risk factors and markers of RA severity both contribute to models predicting CV events. Increasing numbers of both types of factors are associated with greater risk.