Skip to main content

Research Repository

Advanced Search

Cardiovascular risk factors and outcomes in early rheumatoid arthritis: a population-based study

Mallen

Authors



Abstract

Objective To assess the burden of cardiovascular disease (CVD) at and prior to diagnosis in people with early rheumatoid arthritis (RA) and subsequent CVD in these patients.

Methods A retrospective case–control study using a large English primary care database. People with RA (n=6591) diagnosed between 2004 and 2016 (inclusive) were identified using a validated algorithm, matched 1:1 by age and gender to those without RA (n=6591) and followed for a median of 5.4 years. We assessed differences in CVD at, before and after diagnosis, and the impact of traditional and RA-related risk factors (C reactive protein, RA-related autoantibodies and medication use) on incident CVD (a composite of myocardial infarction (MI), stroke or heart failure).

Results RA cases and their matched controls were both of mean age 58.7 (SD 15.5) at cohort entry, and 67.5% were female. Some CVD risk factors were more common at RA diagnosis including smoking and diabetes; however, total and low-density lipoprotein cholesterol were lower in patients with RA. CVD was more common in RA at cohort entry; stroke (3.9% vs 2.7%, p<0.001), heart failure (1.6% vs 1.0%, p=0.001), and non-significantly MI (3.1% vs 2.8%, p=0.092). Excess CVD developed in the 5?years preceding diagnosis. After adjustment for traditional and RA-related risk factors, RA was associated with greater risk of post-diagnosis CVD (HR 1.33, 95%?CI 1.07 to 1.65, p=0.010).

Conclusions An excess of stroke and heart failure occurs before diagnosis of RA. There is excess risk for further cardiovascular events after diagnosis, which is not explained by differences in traditional CVD or RA-related risk factors at diagnosis.

Acceptance Date Feb 19, 2020
Publication Date Mar 24, 2020
Publicly Available Date Mar 28, 2024
Journal Heart
Print ISSN 1355-6037
Publisher BMJ Publishing Group
DOI https://doi.org/10.1136/heartjnl-2019-316193
Keywords cardiovascular risk; outcomes; early rheumatoid arthritis; population-based.
Publisher URL http://dx.doi.org/10.1136/heartjnl-2019-316193