Rabia Agca1,2, Luuk H G A Hopman3,4, Koen J C Laan3,4, Vokko P van Halm3,4, Mike J L Peters3,4, Yvo M Smulders3,4, Jacqueline M Dekker3,4, Giel Nijpels3,4, Coen D A Stehouwer3,4, Alexandre E Voskuyl3,4, Maarten Boers3,4, Willem F Lems3,4, Michael T Nurmohamed3,4. 1. From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands. r_agca@hotmail.com. 2. R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam. r_agca@hotmail.com. 3. From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands. 4. R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam.
Abstract
OBJECTIVE: Cardiovascular (CV) disease (CVD) risk is increased in rheumatoid arthritis (RA). However, longterm followup studies investigating this risk are scarce. METHODS: The CARRÉ (CARdiovascular research and RhEumatoid arthritis) study is a prospective cohort study investigating CVD and its risk factors in 353 patients with longstanding RA. CV endpoints were assessed at baseline and 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: Ninety-five patients with RA developed a CV event over 2973 person-years, resulting in an incidence rate of 3.20 per 100 person-years. Two hundred fifty-seven CV events were reported in the reference cohort during 18,874 person-years, resulting in an incidence rate of 1.36 per 100 person-years. Age- and sex-adjusted 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 nondiabetic 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 CVD (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. Patients with RA have an even higher risk of CVD 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.
OBJECTIVE: Cardiovascular (CV) disease (CVD) risk is increased in rheumatoid arthritis (RA). However, longterm followup studies investigating this risk are scarce. METHODS: The CARRÉ (CARdiovascular research and RhEumatoid arthritis) study is a prospective cohort study investigating CVD and its risk factors in 353 patients with longstanding RA. CV endpoints were assessed at baseline and 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: Ninety-five patients with RA developed a CV event over 2973 person-years, resulting in an incidence rate of 3.20 per 100 person-years. Two hundred fifty-seven CV events were reported in the reference cohort during 18,874 person-years, resulting in an incidence rate of 1.36 per 100 person-years. Age- and sex-adjusted 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 nondiabetic 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 CVD (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. Patients with RA have an even higher risk of CVD 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.
Authors: Vital Da Silva Domingues; Ana M Rodrigues; Sara S Dias; Luís Delgado; Ebrahim Barkoudah; Jaime Branco; Helena Canhão Journal: Rheumatol Int Date: 2021-01-03 Impact factor: 2.631
Authors: Thomas Bieber; Eugen Feist; Alan D Irvine; Masayoshi Harigai; Ewa Haladyj; Susan Ball; Walter Deberdt; Maher Issa; Susanne Grond; Peter C Taylor Journal: Adv Ther Date: 2022-09-05 Impact factor: 4.070