Cardiovascular Event Risk in Rheumatoid Arthritis Compared with Type 2 Diabetes: A 15-year Longitudinal Study

Abstract

Objective.Cardiovascular (CV) disease (CVD) risk is increased in rheumatoid arthritis (RA). However, longterm followup studies investigating this risk are scarce.Methods.The CARRÉ (CARdiovascular research and RhEumatoid arthritis) study is a prospective cohort study investigating CVD and its risk factors in 353 patients with longstanding RA. CV endpoints were assessed at baseline and 3, 10, and 15 years after the start of the study and are compared to a reference cohort (n = 2540), including a large number of patients with type 2 diabetes (DM).Results.Ninety-five patients with RA developed a CV event over 2973 person-years, resulting in an incidence rate of 3.20 per 100 person-years. Two hundred fifty-seven CV events were reported in the reference cohort during 18,874 person-years, resulting in an incidence rate of 1.36 per 100 person-years. Age- and sex-adjusted HR for CV events were increased for RA (HR 2.07, 95% CI 1.57–2.72, p < 0.01) and DM (HR 1.51, 95% CI 1.02–2.22, p = 0.04) compared to the nondiabetic participants. HR was still increased in RA (HR 1.82, 95% CI 1.32–2.50, p < 0.01) after additional adjustment for CV risk factors. Patients with both RA and DM or insulin resistance had the highest HR for developing CVD (2.21, 95% CI 1.01–4.80, p = 0.046 and 2.67, 95% CI 1.30–5.46, p < 0.01, respectively).Conclusion.The incidence rate of CV events in established RA was more than double that of the general population. Patients with RA have an even higher risk of CVD than patients with DM. This risk remained after adjustment for traditional CV risk factors, suggesting that systemic inflammation is an independent contributor to CV risk.

Effect of methotrexate use on the development of type 2 diabetes in rheumatoid arthritis patients: A systematic review and meta-analysis

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Usefulness of CHA2DS2‐VASc score to predict mortality and hospitalization in patients with inflammatory arthritis

“…A sample size of 385 patients was estimated (using the PS Power and Sample Size Calculations software version 3.0) to provide a 95% power at the 0.01 level of statistical significance to detect an imaginable CV event rate and any (CV or non‐CV) rate event of 10% and 30% at 36‐months follow up, respectively. This assumption was based on the analyses of the CARRE study and of 1 of our previous longitudinal studies …”

Pathogenesis of ischaemic and non-ischaemic heart diseases in rheumatoid arthritis

“…Ischaemic heart disease is an important cause of cardiovascular death in patients with RA 18. The risk of arterial (including peripheral and coronary) disease or myocardial infarction in RA is comparable to that in diabetes mellitus 19 20. The incidence of myocardial infarction was 70% higher than that in the general population and corresponded with the incidence of myocardial infarction in 10-year-older non-RA subjects 19.…”