Cardiovascular risk comorbidities in rheumatoid arthritis patients and the use of anti-rheumatic drugs: a cross-sectional real-life study

Abstract

Background Rheumatoid arthritis (RA) is a common autoimmune systemic inflammatory disease. In addition to joint involvement, RA patients frequently have other comorbidities, such as cardiovascular diseases. Drugs used for RA treatment may increase or decrease the risk of a cardiovascular event. This study aims to analyze cardiovascular risk comorbidities in patients with RA and the correlation with the use of anti-rheumatic drugs. Methods Cross-sectional study conducted based on the real-life rheumatoid arthritis study database – REAL, a prospective observational cohort study. Associations between the use of anti-rheumatic drugs and the presence of comorbidities were represented by their prevalence ratio and evaluated using the Chi-square or Fisher’s Exact tests. Results We assessed 1116 patients, 89.4% women, mean age of 55.15 years and predominance of seropositive disease. 63.3% had some cardiovascular comorbidity, predominantly hypertension (49.9%). The use of glucocorticoids was observed in 47.4% of patients and there was a significant tendency of lower use of these drugs in the presence of dyslipidemia (PR: 0.790; p = 0.007). We observed that the presence of cardiovascular comorbidities was associated with higher use of bDMARDs (PR:1.147; p = 0.003). Conclusions The presence of cardiovascular risk comorbidities was confirmed to be higher in RA patients. Different treatment strategies using less glucocorticoids in the presence of dyslipidemia and more common use of bDMARDs in patients with cardiovascular comorbidities suggest that rheumatologists are aware of the potential influence of the DMARDs in the risk of cardiovascular event. Reinforcing these results, we highlight the need for a better baseline assessment to guide the choice of anti-rheumatic drugs in RA patients who have comorbidities.

Management of Rheumatoid Arthritis: An Overview

“…Controlling the inflammatory process with DMARDs, especially targeted therapy, is linked to a lower risk of CVD [ 145 , 146 ]. A recent cross-sectional real-life study reported that the use of less glucocorticoids and an increasing use of bDMARDs in patients with cardiovascular comorbidities suggested that rheumatologists have become aware of the potential influence that RA drugs may have on comorbidities [ 147 ].…”

Cardiovascular health worsening in patients with autoimmune rheumatological diseases during the COVID-19 pandemic

“…Various studies carried out before the pandemic documented a prevalence of 15% in patients with RMD, which was reflected in studies carried out during the pandemic, where the prevalence of diabetes mellitus in patients with RA was 14.9% [ 19 , 51 ], although in another study carried out in 2021, a prevalence of 25.02% was found in patients with rheumatological diseases, mainly RA and SLE [ 52 ]. These data could point to a slight increase in this comorbidity in patients with RA and SLE, although more studies are needed to clarify this potential increase.…”

“…From RA patients, 280 were at risk of anxiety and 227 of depression; from SLE patients, 56 were at risk of anxiety, and 50 were at risk of depression. [ 17 ] Ireland RMDs and COVID-19 from database C19-GRA 212 625.5% ever smoked 71.7% were hospitalized ( p =0.01), and 20.4% died ( p =0.02) [ 18 ] Brazilian teaching hospitals (Ceará, Minas Gerais, and Rio Grande do Sul) Patients over 18 years of both sexes diagnosed with RA 791 15% had DM II, 9.2% had SAH, 34.3% had dyslipidemia, and 26.9% had obesity by BMI RA patients with increased WC have more CVR factors (such as DM II (31.2%), SAH (80.2%), and dyslipidemia (50.0%)) and these variables have an independent influence on the prevalence of obesity [ 19 ] Latin America, 2021 Rheumatologic patients during lockdown 3502 (1694 with RA and 1012 with SLE) Hypertension, depression, and anxiety The most common self-reported comorbidities were hypertension (669 patients; 19.1%) and depression/anxiety (455; 13.3%) [ 20 ] France (including French overseas territories) SLE patients recruited by their specialist or from AFL + 536 questionnaires from individual SLE patients Not mentioned Screening for anxiety and depression was positive for 47.6% and 41.5%, respectively. Difficulties accessing medical care were the only significantly associated factor to anxiety (OR = 1.94, p = 0.012).…”

Von Willebrand Factor and Intima-Media Thickness in Patients With Rheumatoid Arthritis: A Cross-Sectional Study

“…It is noteworthy that the high risk of CVD in RA patients is related to the underestimation of non-traditional risk factors for CVD, as well as to suboptimal management of the disease [6]. As the degree of CVD involvement in RA correlates with the degree of systemic inflammation, basic synthetic diseasemodifying antirheumatic drugs (DMARDs) and biologic DMARDs protect against cardiovascular events, whereas chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticosteroids (GCs) increases CVD risk [7]. In addition, in patients with active RA, in contrast to the general population, an increased rate of cardiovascular events and mortality is paradoxically associated with a decrease in the level of circulating lipids [8,9].…”