Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study

Abstract

IntroductionWe analyzed the prevalence of cardiovascular (CV) disease in patients with rheumatoid arthritis (RA) and its association with traditional CV risk factors, clinical features of RA, and the use of disease-modifying antirheumatic drugs (DMARDs) in a multinational cross-sectional cohort of nonselected consecutive outpatients with RA (The Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis Program, or QUEST-RA) who were receiving regular clinical care.MethodsThe study involved a clinical assessment by a rheumatologist and a self-report questionnaire by patients. The clinical assessment included a review of clinical features of RA and exposure to DMARDs over the course of RA. Comorbidities were recorded; CV morbidity included myocardial infarction, angina, coronary disease, coronary bypass surgery, and stroke. Traditional risk factors recorded were hypertension, hyperlipidemia, diabetes mellitus, smoking, physical inactivity, and body mass index. Unadjusted and adjusted hazard ratios (HRs) (95% confidence interval [CI]) for CV morbidity were calculated using Cox proportional hazard regression models.ResultsBetween January 2005 and October 2006, the QUEST-RA project included 4,363 patients from 48 sites in 15 countries; 78% were female, more than 90% were Caucasian, and the mean age was 57 years. The prevalence for lifetime CV events in the entire sample was 3.2% for myocardial infarction, 1.9% for stroke, and 9.3% for any CV event. The prevalence for CV risk factors was 32% for hypertension, 14% for hyperlipidemia, 8% for diabetes, 43% for ever-smoking, 73% for physical inactivity, and 18% for obesity. Traditional risk factors except obesity and physical inactivity were significantly associated with CV morbidity. There was an association between any CV event and age and male gender and between extra-articular disease and myocardial infarction. Prolonged exposure to methotrexate (HR 0.85; 95% CI 0.81 to 0.89), leflunomide (HR 0.59; 95% CI 0.43 to 0.79), sulfasalazine (HR 0.92; 95% CI 0.87 to 0.98), glucocorticoids (HR 0.95; 95% CI 0.92 to 0.98), and biologic agents (HR 0.42; 95% CI 0.21 to 0.81; P < 0.05) was associated with a reduction of the risk of CV morbidity; analyses were adjusted for traditional risk factors and countries.ConclusionIn conclusion, prolonged use of treatments such as methotrexate, sulfasalazine, leflunomide, glucocorticoids, and tumor necrosis factor-alpha blockers appears to be associated with a reduced risk of CV disease. In addition to traditional risk factors, extra-articular disease was associated with the occurrence of myocardial infarction in patients with RA.

Adiponectin and leptin serum concentrations in patients with rheumatoid arthritis

“…Life expectancy in RA patients (pts) is reduced by an average of 3 to 18 years in comparison with non RA population [1,2]. One of the most frequent causes of death is cardiovascular disease (CVD), due to the development of premature, accelerated atherosclerosis [1,2,3].…”

“…One of the most frequent causes of death is cardiovascular disease (CVD), due to the development of premature, accelerated atherosclerosis [1,2,3].…”

Cardiovascular disease in autoimmune rheumatic diseases

“…Основной причиной преждевре-менной летальности при РА являются атеро-склероз и его осложнения [2]. Риск кардио-васкулярных катастроф высок не только при большей длительности РА, но и у молодых пациентов, серопозитивных по ревматоид-ному фактору (РФ), уже в первые годы забо-левания [3].…”

First Time Myocardial Infarction in a Rheumatic Patient after Elective Arthroplasty

“…Along with controlling traditional risk factors, there is compelling evidence that targeted therapies for controlling the effects of inflammation in RA may help to attenuate perioperative risk. Large registry studies, not specifically addressing the perioperative period, demonstrated tumor necrosis factor antagonist biologics, disease modifying anti-rheumatic drugs such as methotrexate and statins significantly lower cardiovascular risk [10,13,16].…”