Risk factors for venous thromboembolism and atherosclerotic cardiovascular disease: do they differ in patients with rheumatoid arthritis?

Abstract

ObjectiveVenous thromboembolism (VTE) is an increasing concern in rheumatoid arthritis (RA) with little known about risk factors. We aimed to compare risk factors for unprovoked VTE and atherosclerotic cardiovascular disease (ASCVD) in patients with RA and to assess subsequent ASCVD risk after an unprovoked VTE.MethodsPeople with RA participating in a US-wide longitudinal observational registry from 1998 to 2018 were assessed for incident unprovoked VTE (deep venous thrombosis and pulmonary emboli not associated with cancer, recent surgery, hospitalisation, fracture and pregnancy) and ASCVD (myocardial infarction and stroke) validated from hospital/death records. Risk factors for VTE and ASCVD and the risk of ASCVD after an unprovoked VTE were determined using Cox proportional hazards models.ResultsDuring median (IQR) 4 (1.5–7) years of follow-up in 31 366 patients with RA, 539 unprovoked VTE and 1648 ASCVD events were identified. The adjusted models showed increased VTE and ASCVD risk with older age, male sex, comorbidities, prior fracture, worse disability, higher disease activity and glucocorticoids. Traditional cardiovascular disease risk factors were common in both ASCVD and VTE but only increased ASCVD risk with obesity as the exception (VTE HR (95% CI), 1.46 (1.13–1.87)) and ASCVD, 0.58 (0.50–0.68)). ASCVD risk doubled after an unprovoked VTE (HR (95% CI), 2.05 (1.43–2.95)).ConclusionOur findings suggest that unprovoked VTE is mediated by inflammation of RA and may be considered a spectrum of pan-cardiovascular syndrome.

[Retracted] Study on the Correlation between the Prevalence of Venous Thromboembolism in Kazak Pregnant and Lying‐In Women in Xinjiang

“…The linkage disequilibrium of the three polymorphic loci is calculated by Haploview 4.3 software. The Hardy–Weinberg equilibrium test is performed on the three candidate loci of FII using plink software [ 23 ].…”

Challenges in Implementing Cardiovascular Risk Scores for Assessment of Young People With Childhood-Onset Autoimmune Rheumatic Conditions

“…In a large cohort of 31,366 adult patients with RA, there were 1,648 CVD events over a median period of 4 years and the higher ASCVD risk score was associated with the male sex, older age, presence of comorbidities, worse disability, prior fracture, higher disease activity, and glucocorticoid use ( 48 ), suggesting that CVR assessment for primary prevention of CVD using validated tools are more tailored to detect CVR in older age. A large study including 1,050 RA patients also found that FRS, RRS, and SCORE all underestimated CVR associated with RA, while the QRISK2 score tended to overestimate it ( 49 ).…”

Venous Thromboembolism in Rheumatoid Arthritis: The Added Effect of Disease Activity to Traditional Risk Factors

“…59,60 In addition, the occurrence of the first VTE was associated with a threefold increased risk of cardiovascular disease in patients. 61 RA disease activity is associated with an increased risk of VTE. 61,62 In a recent Swedish cohort, the risk of VTE increased twofold in patients with evidence of disease activity compared to patients in remission.…”

“…61 RA disease activity is associated with an increased risk of VTE. 61,62 In a recent Swedish cohort, the risk of VTE increased twofold in patients with evidence of disease activity compared to patients in remission. 62 Although it has been proposed that longer disease duration increases the risk of VTE, 59,63 many studies have shown that the relative risk is higher in the first year and remains relatively stable 234 in subsequent years.…”

“…56,58,60,64,65 Several studies have observed an association between increased body mass index and risk of VTE. 56,61,63,66,67 In a recent Italian cohort, obesity was associated with a hazard ratio (HR) of 1.37 for developing VTE. 63 In another study by Ozen et al, obesity was found to be associated with an increased risk of VTE (HR 1.46 (95% CI), (1.13-1.87)) 61 (Table 2).…”