MiscellaneousCardiovascular Outcomes in Male Veterans With Rheumatoid Arthritis
Section snippets
Methods
VARA is a multicenter prospective registry of patients with RA treated at Veterans Affairs medical centers. The present study included only patients from the Dallas Veterans Affairs Medical Center aged ≥50 years at the time of enrollment. All patients met American College of Rheumatology diagnostic criteria for RA.17 In addition to serving as a biologic repository for both serum and deoxyribonucleic acid, VARA included baseline and longitudinal clinical data collected and recorded during the
Results
Men comprised >90% of the sample (282 of 312 patients). Therefore, our analyses focused on only men with RA enrolled in the VARA Registry. Mean age was 65.2 ± 11.2 years and most were Caucasian (79%). Baseline characteristics are listed in Table 1.
During a mean follow-up of 4.4 ± 2 years, 92 of 282 study subjects (32.6%; 95% confidence interval [CI] 27 to 38) experienced an MACE. Of 92 patients, 38 (42%) had an acute coronary syndrome requiring hospitalization, 37 experienced new-onset
Discussion
Our study shows for the first time that (1) men >50 years of age with RA were at high risk of MACEs, and (2) RA disease activity was a significant predictor of MACEs independent of traditional CV risk factors in a male population of US veterans.
The annual MACE rate in our study was high at ∼8%, nearly double the rate of the general US population (6), and agreed with similar observations made in many earlier studies. A similar >2-fold higher risk of myocardial infarction was reported in women
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Cited by (27)
Cardiovascular disease in inflammatory rheumatic diseases
2016, Best Practice and Research: Clinical RheumatologyCitation Excerpt :High CRP levels conferred risk of CVD even in RA patients in whom the disease was clinically quiescent. A baseline disease activity score 28 of ≥5.1, which indicates high disease activity, was shown to be a predictor of CV events in RA [84]. As discussed before, CRP levels were found to correlate with thicker cIMT in a study involving 47 patients with RA without traditional CVRFs at the time of the carotid US assessment [31], and in another study, the annual mean CRP level was associated with the risk of CV events and CV mortality in long-standing RA patients [85].
Cardiovascular Risk in Inflammatory Rheumatic Disease
2016, Kelley and Firestein's Textbook of Rheumatology: Volumes 1-2, Tenth EditionCardiovascular Risk in Rheumatic Disease
2012, Kelley's Textbook of Rheumatology: Volume 1-2, Ninth EditionRheumatoid arthritis
2010, Best Practice and Research: Clinical RheumatologyCitation Excerpt :Therefore, conclusions from co-morbidity studies should be judged cautiously. In the vast majority of studies, patients with RA show a higher risk of major adverse CV events than controls, and RA activity appears as a predictor of major adverse CV events independent of traditional CV risk factors [31–33]. Patients with very early disease, or even pre-RA, may also be at risk [34,35].
Cardiovascular complications of rheumatoid arthritis: Assessment, prevention, and treatment
2010, Rheumatic Disease Clinics of North AmericaCitation Excerpt :CV events occur approximately a decade earlier in RA than in controls21 and patients with RA are twice as likely to suffer a myocardial infarction6,8,16 with the increased relative risk for CV events being concentrated in younger patients with RA and individuals without known prior CV events.22 However, in a population of male United States' veterans older than 50 years, RA has also been associated with a higher risk for major adverse CV events, particularly in patients with increased disease activity independent of traditional risk factors.23 Patients with prolonged arthritis have more atherosclerosis than patients of the same age with more recent disease onset, suggesting that atherogenesis accelerates after the onset of RA.24,25