Cardiovascular risk factors and outcomes in early rheumatoid arthritis: a population-based study

Objective To assess the burden of cardiovascular disease (CVD) at and prior to diagnosis in people with early rheumatoid arthritis (RA) and subsequent CVD in these patients.

Methods A retrospective case-control study using a large English primary care database. People with RA (n=6,591) diagnosed between 2004 and 2016 (inclusive) were identified using a validated algorithm, matched 1:1 by age and gender to those without RA (n=6,591), and followed for a median of 5.4 years. We assessed differences in CVD at, before, and after diagnosis, and the impact of traditional and RA-related risk factors (C-reactive protein [CRP], RA-related autoantibodies, and medication use) on incident CVD (a composite of myocardial infarction [MI], stroke or heart failure).

Results Cases and controls both had n=4,449 (67.5%) females and mean age 58.7 (SD 15.5) years. Some CVD risk factors were more common at RA diagnosis including smoking, and diabetes, however total and LDL cholesterol were lower in RA patients. CVD was more common in RA at diagnosis; non-significantly MI (3.1% vs. 2.8%, p=0.092), stroke (3.9% vs. 2.7%, p<0.001) and heart failure (1.6% vs. 1.0%, p=0.001). Excess CVD developed in the five years preceding diagnosis. After adjustment for traditional and RA-related risk factors, RA was associated with greater risk of post-diagnosis CVD (HR 1.33, 95%CI 1.07-1.65, p=0.010).

Conclusions An excess of stroke and heart failure occurs before diagnosis of RA. There is excess risk for further cardiovascular events after diagnosis which is not explained by differences in traditional CVD or RA-related risk factors at diagnosis.