Both markers of rheumatoid arthritis severity and traditional markers of cardiovascular risk are important and independent predictors of future CV events among patients who have RA, according to a report published in the Annals of the Rheumatic Diseases.
Clinicians therefore can target both types of markers to reduce the incidence of CV events, which are the major source of mortality in patients with RA, said Dr. Daniel H. Solomon, chief of the section of clinical sciences in the division of rheumatology, immunology, and allergy at the Brigham and Women’s Hospital, Boston, and his associates.
The investigators examined the relative importance of the two types of markers in predicting CV events using a large, longitudinal cohort of RA patients: subjects enrolled in CORRONA (Consortium of Rheumatology Researchers of North America), which includes more than 17,000 patients treated by 268 academic and community rheumatologists at 103 medical centers across the United States. Enrollment began in 2002, and patients were followed through 2006.
For this analysis, published online May 5, 10,156 subjects were followed for a median of 22 months for the development of incident MI, stroke, or transient ischemic attack. Cases of heart failure, peripheral artery disease, and CV-related death were excluded from the study.
The study subjects’ mean age was 59 years, and 75% were women. Median disease duration at baseline was 7 years.
There were 29 MIs and 47 strokes or TIAs during follow-up, for an event rate of approximately 4 per 1,000 person-years.
Six traditional markers of CV risk – hypertension, diabetes, hyperlipidemia, current tobacco use, known cardiovascular disease, and a family history of premature (at age 50 years or younger) CV events – were important predictors of CV events during follow-up. In addition, seven markers of RA severity – disease duration greater than 5 years, radiographically evident joint erosions, subcutaneous nodules, prior total joint replacement, a score of 2 or more on the modified Health Assessment Questionnaire, a score of 23 or more on the Clinical Disease Activity Index, and seropositivity for rheumatoid factor – were strong, independent predictors of CV risk.
Moreover, the incidence of CV events escalated as the number of either type of risk factor increased. The incidence was 0 among patients with no CV risk factors and no markers of RA severity, and it rose to 7.5 per 1,000 person-years in patients with two or more CV risk factors and three or more markers of RA severity, Dr. Solomon and his colleagues said (Ann. Rheum. Dis. 2010;69:1920-5).
In statistical models that incorporated both types of risk factors plus patient age and sex, the predictive value was comparable to that calculated using the Framingham risk score, they noted.
“These results suggest that strategies to reduce CV risk should focus on a strategy of controlling both traditional CV risk factors as well as controlling RA severity,” the investigators said.
They added that a large clinical trial assessing use of statins for the primary prevention of CV events in RA patients is now under way, with results expected as early as 2011.
There was no specific support for this analysis. CORRONA has received general support in the last 2 years from Abbott, Amgen, BMS, Centocor, Genentech, Lilly, and Roche. Dr. Solomon receives support from the National Institutes of Health, the Agency for Healthcare Quality and Research, the Arthritis Foundation, Abbott, and Amgen.