Traditional cardiovascular risk factors and residual disease activity are associated with atherosclerosis progression in rheumatoid arthritis patients

Dalbeni, Andrea; Giollo, Alessandro; Bevilacqua, Michele; Cioffi, Giovanni; Tagetti, Angela; Cattazzo, Filippo; Orsolini, Giovanni; Ognibeni, Federica; Minuz, Pietro; Rossini, Maurizio; Fava, Cristiano; Viapiana, Ombretta

doi:10.1038/s41440-020-0441-1

Cited by 24 publications

(19 citation statements)

References 37 publications

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“…Similar conclusions were drawn by Nikiphorou et al, who reported that current smoking, BMI and diabetes were associated with a higher rate of CVD among patients with RA [19]. At a subclinical level, traditional risk factors (age, mean arterial pressure and diabetes) have also been shown to be independently associated with worsening atherosclerosis in patients with RA who had not experienced previous CV events [39].…”

Section: Risk Factors For Cvd In Patients With Rasupporting

confidence: 76%

“…The presence of traditional risk factors does not fully account for the increased CVD risk in patients with RA, with many studies reporting that a considerable residual risk remains even after adjustment for traditional risk factors [19,20,24]. Systemic inflammation may, at least in part, explain the remaining risk, and this theory is supported by a multitude of studies demonstrating an association between high RA disease activity and increased CVD risk (Table 2) [24,28,[39][40][41][42][43][44]. The relationship between chronic inflammation and CVD remains to be fully delineated, but it has been reported that the proinflammatory mechanisms underlying the pathogenesis of RA may contribute to the development of atherosclerosis [45][46][47], promotion of cardiac remodelling [48], alterations in lipid blood profiles [49] and changes to the morphology of red blood cells [50] (Figure 1).…”

Section: Risk Factors For Cvd In Patients With Ramentioning

confidence: 99%

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The Key Comorbidities in Patients with Rheumatoid Arthritis: A Narrative Review

Taylor

Atzeni

Balsa

et al. 2021

JCM

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Comorbidities in patients with rheumatoid arthritis (RA) are often associated with poor health outcomes and increased mortality. Treatment decisions should take into account these comorbidities due to known or suspected associations with certain drug classes. In clinical practice, it is critical to balance potential treatment benefit against the possible risks for comorbidities as well as the articular manifestations of RA. This review summarises the current literature relating to prevalence and risk factors for the important comorbidities of cardiovascular disease, infections, lymphomas and nonmelanoma skin cancers in patients with RA. The impact on patient outcomes and the interplay between these comorbidities and the therapeutic options currently available, including tumour necrosis factor inhibitors and newer biological therapies, are also explored. As newer RA therapies are developed, and patients gain wider and earlier access to advanced therapies, in part due to the emergence of biosimilars, it is important to consider the prevention or treatment of comorbidities as part of the overall management of RA.

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Section: Risk Factors For Cvd In Patients With Rasupporting

confidence: 76%

Section: Risk Factors For Cvd In Patients With Ramentioning

confidence: 99%

The Key Comorbidities in Patients with Rheumatoid Arthritis: A Narrative Review

Taylor

Atzeni

Balsa

et al. 2021

JCM

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“…Our study is the first study of its type to link multimorbidity in RA with MACE outcomes. Existing research has highlighted that RA increases the risk of cardiovascular events, and that individual LTCs such as diabetes and hypertension are risk factors 30 ; however, to date, no study has shown an association between Open access multimorbidity and MACE outcomes in people with RA. Collectively, the results presented here report for the first time the magnitude of adverse outcomes associated with multimorbidity in those with RA.…”

Section: Discussionmentioning

confidence: 99%

Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants

et al. 2020

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ObjectiveTo investigate how the type and number of long-term conditions (LTCs) impact on all-cause mortality and major adverse cardiovascular events (MACE) in people with rheumatoid arthritis (RA).DesignPopulation-based longitudinal cohort study.SettingUK Biobank.ParticipantsUK Biobank participants (n=502 533) aged between 37 and 73 years old.Primary outcome measuresPrimary outcome measures were risk of all-cause mortality and MACE.MethodsWe examined the relationship between LTC count and individual comorbid LTCs (n=42) on adverse clinical outcomes in participants with self-reported RA (n=5658). Risk of all-cause mortality and MACE were compared using Cox’s proportional hazard models adjusted for lifestyle factors (smoking, alcohol intake, physical activity), demographic factors (sex, age, socioeconomic status) and rheumatoid factor.Results75.7% of participants with RA had multimorbidity and these individuals were at increased risk of all-cause mortality and MACE. RA and >4 LTCs showed a threefold increased risk of all-cause mortality (HR 3.30, 95% CI 2.61 to 4.16), and MACE (HR 3.45, 95% CI 2.66 to 4.49) compared with those without LTCs. Of the comorbid LTCs studied, osteoporosis was most strongly associated with adverse outcomes in participants with RA compared with those without RA or LTCs: twofold increased risk of all-cause mortality (HR 2.20, 95% CI 1.55 to 3.12) and threefold increased risk of MACE (HR 3.17, 95% CI 2.27 to 4.64). These findings remained in a subset (n=3683) with RA diagnosis validated from clinical records or medication reports.ConclusionThose with RA and other LTCs, particularly comorbid osteoporosis, are at increased risk of adverse outcomes, although the role of corticosteroids could not be evaluated in this study. These results are clinically relevant for the monitoring and management of RA across the healthcare system, and future clinical guidelines for RA should acknowledge the importance of multimorbidity.

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“…The premature arterial degeneration observed in individuals with autoimmune disease may be a consequence of the chronic inflammation inherent to these disorders [4,5,6,7]. Additionally, the cardiovascular risk profile, significantly worse in individuals with autoimmune diseases than in the general population [8], is directly associated with both carotid IMT and arterial stiffness values [9,10].…”

Section: Introductionmentioning

confidence: 99%

Do individuals with autoimmune disease have increased risk of subclinical carotid atherosclerosis and stiffness?

et al. 2021

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To explore the role of chronic inflammation inherent to autoimmune diseases in the development of subclinical atherosclerosis and arterial stiffness, this study recruited two population-based samples of individuals with and without autoimmune disease (ratio 1:5) matched by age, sex, and education level and with a longstanding (≥6 years) diagnosis of autoimmune disease. Common carotid intima media thickness (IMT) and arterial distensibility and compliance were assessed with carotid ultrasound.Multivariable linear and logistic regression models were adjusted for 10-year cardiovascular risk. In total, 546 individuals with and without autoimmune diseases (91 and 455, respectively) were included. Mean age was 66 years (standard deviation 12), and 240 (43.9%) were women. Arterial stiffness did not differ according to presence of autoimmune diseases. In men, the diagnosis of autoimmune diseases significantly increased common carotid IMT [beta-coefficient (95% confidence interval): 0.058 (0.009; 0.108); p-value=0.022] and the percentage having IMT ≥ percentile 75 [1.012 (0.145; 1.880); p-value=0.022]. Women without autoimmune disease were more likely to have IMT ≥ percentile 75 [-2.181 (-4.214; -0.149); p-value=0.035] but analysis of IMT as a continuous variable did not yield significant results. In conclusion, subclinical carotid atherosclerosis, but not arterial stiffness, was higher in men with autoimmune diseases. Women did not show significant differences in any of these carotid features.Sex was an effect modifier in the association between common carotid IMT values and the diagnosis of autoimmune diseases.

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Traditional cardiovascular risk factors and residual disease activity are associated with atherosclerosis progression in rheumatoid arthritis patients

Cited by 24 publications

References 37 publications

The Key Comorbidities in Patients with Rheumatoid Arthritis: A Narrative Review

The Key Comorbidities in Patients with Rheumatoid Arthritis: A Narrative Review

Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants

Do individuals with autoimmune disease have increased risk of subclinical carotid atherosclerosis and stiffness?

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