Article Figures & Data
Figures
- Figure 1.
Study design of the CARRÉ and Hoorn study cohorts. RA: rheumatoid arthritis; IFG: impaired fasting glucose; DM: type 2 diabetes mellitus.
- Figure 2.
Survival curves of participants with type 2 diabetes mellitus (black) versus the nondiabetic reference population (green), adjusted for age, sex (A), and traditional cardiovascular risk factors (B); nondiabetic participants with rheumatoid arthritis (black) versus the nondiabetic reference population (green), adjusted for age, sex (C), and traditional cardiovascular risk factors (D).
Tables
- Table 1.
Patient characteristics of the RA population and the reference cohort at baseline.
Characteristics RA Population, n = 326 Reference Cohort, n = 1869 Demographics Age, yrs 63 ± 7* 62 ± 7 Women, n (%) 212 (65)* 976 (52) Median inclusion yr 2002 1991 Followup duration, yrs 11.2 (6.1–12.4) 12 (9.5–12.0) CV risk factors Previous CVD, n (%) 48 (15)* 123 (7) Hypertension, n (%) 200 (61)* 601 (32) Smoking, n (%) Never 71 (22)* 630 (34) Former smoker 159 (49)* 666 (36) Current smoker 96 (29)* 562 (30) Pack-yrs 18 (2–38)* 12 (0–28) Glucose status, n (%) Normal fasting glucose levels 283 (87) 1501 (80) IFG levels 26 (8) 206 (11) DM 16 (5) 162 (9) Known/newly diagnosed DM 14/8 73/89 Systolic BP, mmHg 142 ± 20* 135 ± 20 Diastolic BP, mmHg 81 ± 8* 82 ± 10 TC, mmol/l 5.79 ± 1.13* 6.63 ± 1.16 HDL-C, mmol/l 1.45 ± 0.49* 1.32 ± 0.37 LDL-C, mmol/l 3.71 ± 1.04* 4.59 ± 1.06 Triglycerides, mmol/l 1.32 (0.96–1.84) 1.40 (1.00–1.90) TC/HDL-C ratio 4.38 ± 1.55* 5.36 ± 1.72 Waist/hip ratio 0.9 ± 0.1 0.9 ± 0.1 Body mass index, kg/m2 26.7 ± 4.8 26.5 ± 3.4 Medication, n (%) Antihypertensive drugs 84 (26)* 373 (20) Statins 37 (11)* 29 (2) Aspirin 54 (17)* 62 (3) RA-related factors Age at RA diagnosis, yrs 55 ± 8 — Disease duration, yrs 7 (4–10) — IgM-RF ≥ 30 U/ml, n (%) 236 (72) — ACPA ≥ 50 kU/l, n (%) 168 (52) — Erosion on radiographs, n (%) 263 (81) — DAS28, range 0–10 3.9 ± 1.3 — NSAID, n (%) 218 (67) — Biologic agents, n (%) 33 (10) — Methotrexate, n (%) 195 (60) — Prednisone, n (%) 54 (17) — Sulfasalazine, n (%) 53 (16) — Hydroxychloroquine, n (%) 24 (7) — Leflunomide, n (%) 27 (8) — Other DMARD, n (%) 20 (6) — Continuous variables are presented as mean ± SD or median (interquartile range). Categorical and dichotomous variables are presented as numbers and/or percentages.
↵* Significantly different from the general population. CV: cardiovascular; CVD: CV disease; BP: blood pressure; TC: total cholesterol; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; pack-yrs: (packs smoked per day) × (years as a smoker); IFG: impaired fasting glucose; DM: type 2 diabetes mellitus; RA: rheumatoid arthritis; IgM-RF: immunoglobulin M rheumatoid factor; ACPA: anticitrullinated protein antibody; DAS28: Disease Activity Score at 28 joints; DMARD: disease-modifying antirheumatic drug; NSAID: nonsteroidal antiinflammatory drug.
Characteristics RA Population Reference Population p All patients, n 326 1869 Total followup, yrs 2973 18,874 Fatal and nonfatal CV events, n 95 257 Incidence per 100 person-yrs 3.20 1.36 HR RA vs reference cohort Model 1* 1.93 (1.51–2.45) 1.00 < 0.01 Model 2# 1.89 (1.40–2.46) 1.00 < 0.01 Patients with prevalent CVDΔ excluded, n 278 1746 Total followup, yrs 2627 18,008 Fatal and nonfatal CV event, n 69 225 Incidence per 100 person-yrs 2.63 1.25 HR RA vs reference cohort Model 1* 1.75 (1.31–2.32) 1.00 < 0.01 Model 2# 1.96 (1.45–2.66) 1.00 < 0.01 ↵* Adjusted for age and sex.
↵# Adjusted for age, sex, systolic blood pressure, antihypertensive agents, total cholesterol, high-density lipoprotein cholesterol, statins, smoking in pack-years, body mass index, diabetes mellitus, and aspirin.
↵Δ CVD according to the International Classification of Diseases criteria. CV: cardiovascular; RA: rheumatoid arthritis; CVD: CV disease.
Patients HR 95% CI p All patients Model 1 Nondiabetic population 1.00 Reference — DM 1.51 1.02–2.22 0.04 Nondiabetic patients with RA 2.07 1.57–2.72 < 0.01 Model 2 Nondiabetic population 1.00 Reference — DM 1.28 0.85–1.92 0.25 Nondiabetic patients with RA 1.82 1.32–2.50 < 0.01 Patients with prevalent CVD excluded Model 1 Nondiabetic population 1.00 Reference — DM 1.42 0.92–2.21 0.12 Nondiabetic patients with RA 1.82 1.32–2.50 < 0.01 Model 2 Nondiabetic population 1.00 Reference — DM 1.15 0.72–1.84 0.56 Nondiabetic patients with RA 1.96 1.39–2.78 < 0.01 Model 1: adjusted for age and sex. Model 2: adjusted for age, sex, systolic blood pressure, antihypertensive agents, total cholesterol, high-density lipoprotein cholesterol, statins, smoking in pack-years, body mass index, and aspirin. CV: cardiovascular; CVD: CV disease; RA: rheumatoid arthritis; DM: type 2 diabetes mellitus.
All Patients HR 95% CI p Model 1 Reference population, normal glucose tolerance 1.00 Reference — Insulin resistance 1.46 1.04–2.07 0.03 DM 1.51 1.03–2.23 0.04 RA Normal glucose tolerance 2.08 1.58–2.74 < 0.01 Insulin resistance 2.70 1.33–5.49 < 0.01 DM 2.23 1.04–4.75 0.04 Model 2 Reference population, normal glucose tolerance 1.00 Reference — Insulin resistance 1.18 0.82–1.70 0.37 DM 1.30 0.87–1.95 0.20 RA Normal glucose tolerance 1.89 1.37–2.56 < 0.01 Insulin resistance 2.67 1.30–5.46 < 0.01 DM 2.21 1.01–4.80 0.046 Model 1: adjusted for age and sex. Model 2: adjusted for age, sex, systolic blood pressure, antihypertensive agents, total cholesterol, high-density lipoprotein cholesterol, statins, smoking in pack-years, body mass index, aspirin, and prevalent CV disease. CV: cardiovascular; RA: rheumatoid arthritis; IR: insulin resistance; DM: type 2 diabetes mellitus.
Type of Event General Population, n = 1869 RA Population, n = 326 Prevalent, n = 123 Incident, n = 257 Prevalent, n = 48 Incident, n = 95 Myocardial infarction 33 33 42 57 Cerebrovascular accident 17 17 17 20 Transient ischemic attack 5 6 17 16 Peripheral arterial disease 20 25 8 7 Angina pectoris 28 20 17 N.A. Data are in percentages. RA: rheumatoid arthritis; N.A.: not assessed; angina pectoris: chest pain preceding coronary artery bypass graft or percutaneous coronary intervention with stent placement, chest pain with significant ST segment deviation on electrocardiogram, chest pain preceding diagnosis of acute coronary syndrome, chest pain preceding coronary angiography with > 50% stenosis, chest pain preceding positive exercise test. Possibility of more than 1 event previous to baseline.
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