Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Risk of Cardiovascular Disease in Rheumatoid Arthritis Is Independent of Disease Duration and the Level of Disease Activity.
Arts1, Elke.E.A., Fransen1, Jaap, den Broeder2, Alfons, Popa1, Calin, Van Riel1, Piet L.C.M.
Chronic inflammation may act as an independent risk factor for cardiovascular disease (CVD) in rheumatoid arthritis (RA). However, the level of inflammation apparently does not contribute to the risk of CVD in RA patients. Probably, disease duration is more important than the level of inflammation. Indeed, EULAR recommendations for cardiovascular risk management in RA do identify RA disease duration of >10 years as CV risk factor. Hence the objective of this study was to investigate the relationship between duration of inflammation and risk of CVD in RA patients, corrected for the level of inflammation.
All RA patients with a follow-up time of >= 6 months in the Nijmegen early RA cohort without a cardiovascular history were included in this study. The time-averaged DAS28 was calculated for each patient. The effect of disease duration on the risk of developing the first cardiovascular event was estimated by means of Kaplan-Meier survival analysis and Cox proportional hazards regression, including time-averaged DAS28, age and gender as covariates. The incidence of CVD within the first 10 years of the disease was compared with the incidence thereafter, using Kaplan-Meier survival curves and Log-rank testing.
There were 855 patients with 6388 patient years included. Their mean age was 54 years, 66% was female and 76% RF positive, mean baseline DAS28 was 5.0. Ninety-one CV events, including myocardial infarction (MI), cerebrovascular accident (CVA) and heart failure were recorded during follow up. The course of hazards over time (not shown) did not indicate a change in the risk of CVD over disease duration (exposition time), which is also reflected by the absence of a deflection in the survival curves (fig.1a). The CV risk is significantly lower, only in the group of patients with very low DAS28 (<2.9) over time, versus the other groups (p=0.038). The survival distributions did not differ between a disease duration of <10 years or >10 years (Log-rank test: p=0.365) (fig. 1b).
The duration of RA, i.e. the length of time a patient is exposed to inflammation, does not appear to further aggravate the risk of CVD over time. Particularly, the risk of CVD in RA patients was not increased after 10 years of disease duration compared to the first 10 years. The level of disease activity did not influence the risk of CVD, unless disease activity was kept at a very low level.
To cite this abstract, please use the following information:
Arts, Elke.E.A., Fransen, Jaap, den Broeder, Alfons, Popa, Calin, Van Riel, Piet L.C.M.; Risk of Cardiovascular Disease in Rheumatoid Arthritis Is Independent of Disease Duration and the Level of Disease Activity. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2585