RT Journal Article
SR Electronic
T1 Cardiovascular Event Risk in Rheumatoid Arthritis is Higher than in Type 2 Diabetes: a 15 Year Longitudinal Study
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.180726
DO 10.3899/jrheum.180726
A1 R. Agca
A1 L.H.G.A. Hopman
A1 K.C.J. Laan
A1 V.P. van Halm
A1 M.J.L. Peters
A1 Y.M. Smulders
A1 J.M. Dekker
A1 G. Nijpels
A1 C.D.A. Stehouwer
A1 A.E. Voskuyl
A1 M. Boers
A1 W.F. Lems
A1 M.T. Nurmohamed
YR 2019
UL http://www.jrheum.org/content/early/2019/05/13/jrheum.180726.abstract
AB 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.