Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Noncardiac Vascular Disease in Rheumatoid Arthritis (RA): Increase in Venous Thromboembolic Events?

Bacani,  A. Kirstin, Gabriel,  Sherine E., Crowson,  Cynthia S., Matteson,  Eric L.

Purpose:

Patients with rheumatoid arthritis (RA) suffer from an excess burden of cardiovascular disease, but little is known about the incidence of noncardiac vascular disease in RA patients. The purpose of our study was to examine whether the incidence of venous thromboembolic events and other noncardiac vascular disease events has changed in recent years among RA patients and to compare the incidence to that in a non-RA cohort.

Methods:

A population-based inception cohort of RA patients who fulfilled 1987 ACR criteria for RA between 1/1/1980 and 12/31/2007 and a cohort of non-RA subjects from the same underlying population were assembled and followed until death, migration, or the present. The occurrence of venous thromboembolic events (deep venous thrombosis or pulmonary embolism), cerebrovascular events (hemorrhagic stroke, nonhemorrhagic stroke, transient ischemic attack or amaurosis fugax), and peripheral arterial events (abdominal aortic aneurysm, renal artery stenosis, peripheral vascular disease, or arterial thromboembolism), was ascertained by review of the medical record. Cox proportional hazard models were used to compare development of noncardiac vascular disease in RA subjects diagnosed in 1980–1994 to those diagnosed in 1995–2007 and to compare RA patients diagnosed in 1995–2007 to the non-RA comparison cohort.

Results:

The study included 814 RA patients (mean age [SD] 55.9 [15.7] years; 68% women). The average length of follow-up was 9.6 years [SD 6.9] and 66% were rheumatoid factor positive. Among RA patients, the incidence of venous thromboembolic events was more than 3-fold higher in the 1995–2007 time period compared to the 1980–1994 time period (cumulative incidence [±SE] 7.6 ± 1.9 vs 2.4 ± 0.9, respectively; p=0.004). The incidence of cerebrovascular events was similar in the 1995–2007 time period compared to the 1980–1994 time period (cumulative incidence [±SE] 4.4 ± 1.3 vs 3.3 ±1.0, respectively; p=0.52), as was the incidence of peripheral arterial events (cumulative incidence [±SE] 3.5 ± 1.1 vs 3.7 ± 1.1, respectively; p=0.81).

Patients diagnosed with RA in 1995–2007 were compared to non-RA subjects of similar age and sex (mean age [SD] 55.6 [15.5] years; 69% women). RA patients had a higher incidence of venous thromboembolic events compared to non-RA subjects (cumulative incidence [±SE] 7.6 ± 1.9 vs 3.1 ± 1.2, respectively; p=0.003). The incidence of cerebrovascular events was similar between RA patients and non-RA subjects (cumulative incidence [±SE] 4.4 ± 1.3 vs 4.6 ± 1.6, respectively; p=0.38), as was the incidence of peripheral arterial events (cumulative incidence [±SE] 3.5 ± 1.1 vs 4.1 ± 1.6, respectively; p=0.54).

Conclusion:

The incidence of venous thromboembolic events appears to have increased over time among RA patients and is increased in RA patients compared to non-RA subjects. The incidence of cerebrovascular events and peripheral disease events was similar over time among RA patients and was similar in RA patients compared to non-RA subjects. Further investigation is needed to explore the reasons for the increased incidence of venous thromboembolic events among RA patients.

To cite this abstract, please use the following information:
Bacani, A. Kirstin, Gabriel, Sherine E., Crowson, Cynthia S., Matteson, Eric L.; Noncardiac Vascular Disease in Rheumatoid Arthritis (RA): Increase in Venous Thromboembolic Events? [abstract]. Arthritis Rheum 2010;62 Suppl 10 :78
DOI: 10.1002/art.27847

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