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18-09-2017 | Rheumatology | News | Article

RA disease activity and severity play ‘important role’ in reducing CVD risk

medwireNews: Targeting factors such as inflammation and disease activity in patients with rheumatoid arthritis (RA) could help reduce their risk for cardiovascular disease (CVD), study findings suggest.

The transatlantic team of researchers found that nearly a third of CVD events were attributable to RA characteristics in the study, which combined information from patients in 10 countries.

Approximately seven in every 10 CVD events were attributable to a combination of all CV risk factors and RA characteristics, the researchers report.

They believe that “the substantial proportion of CVD risk attributable to RA characteristics indicates that RA disease activity and severity play an important role in efforts to reduce CVD risk among patients with RA.”

Cynthia Crowson (Mayo Clinic, Rochester, Minnesota, USA) and colleagues studied data on CVD risk factors and RA characteristics from 13 rheumatology centers in Europe, South Africa, the USA, Canada, and Mexico.

The study included 5638 patients with RA and no prior CVD, who had a mean age of 55.3 years and of whom 76% were women. RA-specific factors collected at baseline included rheumatoid factor positivity, anticitrullinated protein antibodies positivity, erythrocyte sedimentation rate (ESR), C-reactive protein, and Disease Activity Score including 28 joints using ESR.

During a mean follow-up of 5.8 years, 148 men and 241 women developed a CVD event, including acute coronary syndrome, chronic ischemic heart disease, coronary revascularization, CVD death, cerebrovascular events, and peripheral vascular events. This gave a 10-year cumulative incidence of 20.9% and 11.1%, respectively.

Men had a significantly higher burden of CVD risk factors than women, including increased blood pressure, increased total cholesterol, and smoking prevalence.

But the relative risks for CVD did not differ between men and women. For both genders smoking and hypertension were the traditional CVD risk factors with the highest population attributable risk (PAR), defined as the proportion of disease that could be prevented by eliminating the risk factor. The next highest PAR was for total cholesterol.

The PARs for Disease Activity Score and for seropositivity were comparable in size to the PAR for lipids.

All the CVD risk factors combined explained 49.0% of the CVD risk in patients, while RA characteristics explained 30.3% of the CVD risk. CVD risk factors and RA characteristics together explained 69.6% of the CVD risk.

Writing in the Annals of Rheumatic Diseases, the researchers conclude: “Knowledge regarding the impact of various risk factors on CVD events is essential to individualise CVD risk evaluation and prevention for patients with RA.”

By Anita Chakraverty

medwireNews is an independent medical news service provided by Springer Healthcare. © 2017 Springer Healthcare part of the Springer Nature group