Abstract 2185: High 10-year Cardiovascular (CV) Risk in Newly Diagnosed Rheumatoid Arthritis (RA) Patients
Authors
H. M. Kremers, C. S. Crowson, T. M. Therneau, V. L. Roger, S. E. Gabriel
Purpose:
RA patients are at increased risk for CV events. This risk is increased early in disease, and perhaps even before the onset of clinical symptoms. This purpose of this study was to estimate the age-specific 10-year absolute risk of CV events in newly diagnosed subjects with RA.
Methods:
This study utilized the well published population-based incidence cohort of RA from the Mayo Clinics, and age and sex-matched non-RA subjects, ascertained between 1955-1995. Subjects with a history of CV disease at study entry were excluded. CV risk factor and event data were collected via chart review. The combined CV outcome included MIs, heart failure, coronary revascularization, and CV death. Subjects were followed until death, migration or 1/1/07. Cox regression models were used to estimate the 10-year risk of the combined CV endpoint, with adjustment for conventional CV risk factors. Subjects were classified into five 10-yr absolute risk categories: low-risk (<6% CV risk over the next 10 years), low- moderate (6%-10% risk), intermediate (10%-20 % risk), high (20-50% risk) and very high risk (>50%).
Results:
533 newly diagnosed RA and 574 matched non-RA subjects were followed for a median of 12.0 and 14.7 yrs, respectively. Age (mean 57 yrs) and gender distribution (73% women) were similar in the two groups. The proportion of RA subjects with intermediate or higher 10-yr risk of CV events is shown by decade below:
|
Proportion with intermediate or high |
|
Age |
RA |
Non-RA |
50-50 |
85% |
27% |
60-69 |
100% |
79% |
Furthermore, the proportion of 60-69 year old RA subjects with a high or very high risk of CV events was 85%, compared to only 40% in non-RA subjects. The absolute CV risk in RA subjects was similar to that of non-RA subjects 5-10 years older, and this effect was even more pronounced in women.
Conclusions:
More than half of the 50-59 yr old, and all of the >60 yr old, new RA patients in this study had a 10% or greater risk of CV disease within the subsequent 10 years. RA patients would benefit from aggressive CV risk reduction strategies tailored to their specific risk profiles. Consideration of absolute CV risk categories in RA can facilitate clinical decisions concerning CV disease prevention in RA subjects. Further research is needed to develop RA specific CV risk scores as well as the potential absolute risk reductions with various preventive strategies.
Editorial Comment:
These are very sobering data. It would be of interest, however, to break the cohort down by decades in which disease was diagnosed, as treatment of RA and treatment of CV disease have changed dramatically in the past decade. It is possible that the differential between RA and non-RA, in terms of 10 yr CV risk, might possibly have narrowed in the more recent cohorts. One of the challenges that this study cannot address is identifying the best CV risk reduction strategy for RA patients. Conventional CV risk factors are still the most potent risk factors for CV events in RA (and are what are primarily measured here), as they are in non-RA, subjects but some investigators have suggested that these risk factors are less aggressively managed in RA patients. Recent data from large registry and observational studies suggest that tight control of RA disease activity, whether with MTX and/or biologic therapy, is associated with reduced risk of CV events. For now, a combined aggressive approach is probably the right answer until further RA-specific data are available.
