Disease activity predicts the development of cardiovascular events in patients with rheumatoid arthritis from the CARMA cohort

Objective

To identify significant predictors of cardiovascular (CV) events in rheumatoid arthritis (RA) patients from the CARdiovascular in RheuMAtology (CARMA) project, followed prospectively for 10 years.

Methods

Between July 2010 and January 2012, 708 RA patients were recruited from 67 hospitals across Spain. The study focused on patients with no prior CV events at the time of recruitment. At the 10-year follow-up, data on the occurrence of CV events, patient-years of follow-up and linearized event rates were analyzed. Cox regression analyses were conducted, both crude and adjusted for PREVENT-CVD.

Results

Over 6608 patient-years, 114 patients (16.1%) experienced CV events, yielding a linearized event rate of 1.73 per 100 patient-years. Patients with CV events were older (70.7± 10.6 vs. 62.1±12.8 years, p<0.001), more frequently male (36.0% vs. 20.0%, p<0.001), and had higher rates of hypertension (46.5% vs. 23.4%, p<0.001), diabetes (14% vs. 4.9%, p=0.001), and dyslipidemia (37.7% vs. 27.4%, p=0.03). Higher baseline erythrocyte sedimentation rate (ESR) was also associated with future CV events. Those who developed CV events had a significantly higher predicted 10-year CV risk using the PREVENT-CVD score (18.0% vs. 10.3%, p<0.001). Cox regression analysis adjusted for PREVENT-CVD showed that although higher crude C-reactive protein and uric acid levels were associated with increased CV risk, after adjustment these associations weakened and became non-significant. However, higher disease activity (DAS28-ESR) was linked to greater CV risk, with moderate/high disease activity (DAS28-ESR>3.2) showing a significantly higher adjusted CV risk (HR 1.62; 95% CI: 1.06–22.47, p=0.03).

Conclusions

Disease activity is a key determinant of CV outcomes in RA patients. The PREVENT-CVD score is an effective tool for CV risk stratification in this population.