Should CVD Risk Assessment Algorithms for RA Be Updated?

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This study found two-fold higher rates of acute MI, coronary death, heart failure, cardiac arrest and PAD in RA patients.
This study found two-fold higher rates of acute MI, coronary death, heart failure, cardiac arrest and PAD in RA patients.

A new study published in PLoS One suggests that it may be time to produce new algorithms for assessing cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA). Investigators at the University of Leeds found associations with some but not all types of CVD in those with RA, suggesting a need for new prognostic models.

The researchers analyzed data from 12120 individuals with RA and 121191 individuals without RA. The subjects were 18 years of age or older and were matched by age and sex. All participants were registered with general practices in England that contribute data to CArdiovascular research using LInked Bespoke stud-
ies and Electronic health Records (CALIBER). 

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The study included patients with prospectively recorded RA who were seen between January 1997 and March 2010. The investigators used multivariable random effects Poisson regression models and examined the association between RA and the initial presentation of 12 types of CVD.

The researchers found that CVD developed in 2525 persons with RA and in 18146 persons without RA during a median follow-up of 4.2 years. Interestingly, the investigators found no association with cerebrovascular disease, abdominal aortic aneurysm, or unstable angina in those with RA.  

However, rates of myocardial infarction were significantly higher in those with RA (adjusted incidence ratio [IRR] = 1.43; 95% confidence interval [CI] 1.21-1.70). Rates of unheralded coronary death (IRR = 1.60; 95% CI 1.18-2.18) and heart failure (IRR = 1.61; 95% CI 1.43-1.83), cardiac arrest (HR = 2.26; 95% CI 1.69-3.02), and peripheral arterial disease (HR = 1.36; 95% CI 1.14-1.62) were also higher for those with RA.

“In this contemporary cohort study comparing rates of the first lifetime presentation of the 12 most common symptomatic cardiovascular diseases between people with and without RA, we observed between 36% and two-fold higher incidence rates of myocardial infarction, unheralded coronary death, heart failure, cardiac arrest, and peripheral arterial disease in individuals diagnosed with the disease,” lead study investigator Mar Pujades-Rodriguez, a University Academic Fellow at Leeds Institute of Biomedical and Clinical Sciences at the University of Leeds, England, in an interview with Rheumatology Advisor.

She said that the size of the estimates was generally similar to that observed in people with diabetes and did not differ between men and women. The increased risk for different types of CVD present at both early stages of RA and 10 years or more after diagnosis suggests that the mechanism by which RA increases the risk for CVD is not exclusively related to a cumulative inflammatory burden of disease activity, said Dr Pujades-Rodriguez.

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