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Cardiovascular Event Risk in Rheumatoid Arthritis is Higher than in Type 2 Diabetes: a 15 Year Longitudinal Study

R Agca, L H G A Hopman, K C J Laan, V P van Halm, M J L Peters, Y M Smulders, J M Dekker, G Nijpels, C D A Stehouwer, A E Voskuyl, M Boers, W F Lems, M T Nurmohamed
Journal of Rheumatology 2019 May 15

OBJECTIVE: Cardiovascular (CV) disease risk is increased in rheumatoid arthritis (RA). However, longterm follow-up studies investigating this risk are scarce.

METHODS: CARRÉ is a prospective cohort study investigating CV disease and its risk factors in 353 patients with longstanding RA. CV endpoints were assessed at baseline, 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: 95 RA patients developed a CV event during 2973 person-years, resulting in an incidence rate of 3.20 per 100 person-years. 257 CV events were reported in the reference cohort during 18874 person-years, resulting in an incidence rate of 1.36 per 100 person-years. Age and sex adjusted hazard rates(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 non-diabetic 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 CV disease (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. RA patients have an even higher risk of CV disease 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.


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