Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis.
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Crowson Cynthia S, Rollefstad Silvia, Ikdahl Eirik, Kitas George D, van Riel Piet L C M, Gabriel Sherine E, Matteson Eric L, Kvien Tore K, Douglas Karen, Sandoo Aamer, Arts Elke, Wållberg-Jonsson Solveig, Innala Lena, Karpouzas George, Dessein Patrick H, Tsang Linda, El-Gabalawy Hani, Hitchon Carol, Ramos Virginia Pascual, Yáñez Irazú Contreras, Sfikakis Petros P, Zampeli Evangelia, Gonzalez-Gay Miguel A, Corrales Alfonso, Laar Mart van de, Vonkeman Harald E, Meek Inger, Semb Anne Grete, A Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis (ATACC-RA)
Аннотация
METHODS: In 13 rheumatology centres, data on CVD risk factors and RA characteristics were collected at baseline. CVD outcomes (myocardial infarction, angina, revascularisation, stroke, peripheral vascular disease and CVD death) were collected using standardised definitions.
RESULTS: 5638 patients with RA and no prior CVD were included (mean age: 55.3 (SD: 14.0) years, 76% women). During mean follow-up of 5.8 (SD: 4.4) years, 148 men and 241 women developed a CVD event (10-year cumulative incidence 20.9% and 11.1%, respectively). Men had a higher burden of CVD risk factors, including increased blood pressure, higher total cholesterol and smoking prevalence than women (all p<0.001). Among the traditional CVD risk factors, smoking and hypertension had the highest population attributable risk (PAR) overall and among both sexes, followed by total cholesterol. The PAR for Disease Activity Score and for seropositivity were comparable in magnitude to the PAR for lipids. A total of 70% of CVD events were attributable to all CVD risk factors and RA characteristics combined (separately 49% CVD risk factors and 30% RA characteristics).
CONCLUSIONS: In a large, international cohort of patients with RA, 30% of CVD events were attributable to RA characteristics. This finding indicates that RA characteristics play an important role in efforts to reduce CVD risk among patients with RA.