Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis

Cynthia Crowson, Silvia Rollefstad, Eirik Ikdahl, George D. Kitas, Piet L.C.M. Van Riel, Sherine E. Gabriel, Eric Lawrence Matteson, Tore K. Kvien, Karen Douglas, Aamer Sandoo, Elke Arts, Solveig Wållberg-Jonsson, Lena Innala, George Karpouzas, Patrick H. Dessein, Linda Tsang, Hani El-Gabalawy, Carol Hitchon, Virginia Pascual Ramos, Irazä Contreras YáñezPetros P. Sfkakis, Evangelia Zampeli, Miguel A. Gonzalez-Gay, Alfonso Corrales, Mart Van De Laar, Harald E. Vonkeman, Inger Meek, Anne Grete Semb

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Abstract

Objectives P atients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA. Methods In 13 rheumatology centres, data on CVD risk factors and RA characteristics were collected at baseline. CVD outcomes (myocardial infarction, angina, revascularisation, stroke, peripheral vascular disease and CVD death) were collected using standardised definitions. Results 5638 patients with RA and no prior CVD were included (mean age: 55.3 (SD: 14.0) years, 76% women). During mean follow-up of 5.8 (SD: 4.4) years, 148 men and 241 women developed a CVD event (10-year cumulative incidence 20.9% and 11.1%, respectively). Men had a higher burden of CVD risk factors, including increased blood pressure, higher total cholesterol and smoking prevalence than women (all p<0.001). Among the traditional CVD risk factors, smoking and hypertension had the highest population attributable risk (PAR) overall and among both sexes, followed by total cholesterol. The PAR for Disease Activity Score and for seropositivity were comparable in magnitude to the PAR for lipids. A total of 70% of CVD events were attributable to all CVD risk factors and RA characteristics combined (separately 49% CVD risk factors and 30% RA characteristics). Conclusions In a large, international cohort of patients with RA, 30% of CVD events were attributable to RA characteristics. This finding indicates that RA characteristics play an important role in efforts to reduce CVD risk among patients with RA.

Original languageEnglish (US)
Pages (from-to)48-54
Number of pages7
JournalAnnals of the Rheumatic Diseases
Volume77
Issue number1
DOIs
StatePublished - Jan 1 2018

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Rheumatoid Arthritis
Cardiovascular Diseases
Rheumatoid Factor
Smoking
Cholesterol
Population
Hypertension
Peripheral Vascular Diseases
Rheumatology
Blood pressure
Sex Characteristics
Stroke
Myocardial Infarction
Lipids

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

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Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis. / Crowson, Cynthia; Rollefstad, Silvia; Ikdahl, Eirik; Kitas, George D.; Van Riel, Piet L.C.M.; Gabriel, Sherine E.; Matteson, Eric Lawrence; Kvien, Tore K.; Douglas, Karen; Sandoo, Aamer; Arts, Elke; Wållberg-Jonsson, Solveig; Innala, Lena; Karpouzas, George; Dessein, Patrick H.; Tsang, Linda; El-Gabalawy, Hani; Hitchon, Carol; Ramos, Virginia Pascual; Yáñez, Irazä Contreras; Sfkakis, Petros P.; Zampeli, Evangelia; Gonzalez-Gay, Miguel A.; Corrales, Alfonso; Van De Laar, Mart; Vonkeman, Harald E.; Meek, Inger; Semb, Anne Grete.

In: Annals of the Rheumatic Diseases, Vol. 77, No. 1, 01.01.2018, p. 48-54.

Research output: Contribution to journalArticle

Crowson, C, Rollefstad, S, Ikdahl, E, Kitas, GD, Van Riel, PLCM, Gabriel, SE, Matteson, EL, Kvien, TK, Douglas, K, Sandoo, A, Arts, E, Wållberg-Jonsson, S, Innala, L, Karpouzas, G, Dessein, PH, Tsang, L, El-Gabalawy, H, Hitchon, C, Ramos, VP, Yáñez, IC, Sfkakis, PP, Zampeli, E, Gonzalez-Gay, MA, Corrales, A, Van De Laar, M, Vonkeman, HE, Meek, I & Semb, AG 2018, 'Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis', Annals of the Rheumatic Diseases, vol. 77, no. 1, pp. 48-54. https://doi.org/10.1136/annrheumdis-2017-211735
Crowson, Cynthia ; Rollefstad, Silvia ; Ikdahl, Eirik ; Kitas, George D. ; Van Riel, Piet L.C.M. ; Gabriel, Sherine E. ; Matteson, Eric Lawrence ; Kvien, Tore K. ; Douglas, Karen ; Sandoo, Aamer ; Arts, Elke ; Wållberg-Jonsson, Solveig ; Innala, Lena ; Karpouzas, George ; Dessein, Patrick H. ; Tsang, Linda ; El-Gabalawy, Hani ; Hitchon, Carol ; Ramos, Virginia Pascual ; Yáñez, Irazä Contreras ; Sfkakis, Petros P. ; Zampeli, Evangelia ; Gonzalez-Gay, Miguel A. ; Corrales, Alfonso ; Van De Laar, Mart ; Vonkeman, Harald E. ; Meek, Inger ; Semb, Anne Grete. / Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis. In: Annals of the Rheumatic Diseases. 2018 ; Vol. 77, No. 1. pp. 48-54.
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abstract = "Objectives P atients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA. Methods In 13 rheumatology centres, data on CVD risk factors and RA characteristics were collected at baseline. CVD outcomes (myocardial infarction, angina, revascularisation, stroke, peripheral vascular disease and CVD death) were collected using standardised definitions. Results 5638 patients with RA and no prior CVD were included (mean age: 55.3 (SD: 14.0) years, 76{\%} women). During mean follow-up of 5.8 (SD: 4.4) years, 148 men and 241 women developed a CVD event (10-year cumulative incidence 20.9{\%} and 11.1{\%}, respectively). Men had a higher burden of CVD risk factors, including increased blood pressure, higher total cholesterol and smoking prevalence than women (all p<0.001). Among the traditional CVD risk factors, smoking and hypertension had the highest population attributable risk (PAR) overall and among both sexes, followed by total cholesterol. The PAR for Disease Activity Score and for seropositivity were comparable in magnitude to the PAR for lipids. A total of 70{\%} of CVD events were attributable to all CVD risk factors and RA characteristics combined (separately 49{\%} CVD risk factors and 30{\%} RA characteristics). Conclusions In a large, international cohort of patients with RA, 30{\%} of CVD events were attributable to RA characteristics. This finding indicates that RA characteristics play an important role in efforts to reduce CVD risk among patients with RA.",
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T1 - Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis

AU - Crowson, Cynthia

AU - Rollefstad, Silvia

AU - Ikdahl, Eirik

AU - Kitas, George D.

AU - Van Riel, Piet L.C.M.

AU - Gabriel, Sherine E.

AU - Matteson, Eric Lawrence

AU - Kvien, Tore K.

AU - Douglas, Karen

AU - Sandoo, Aamer

AU - Arts, Elke

AU - Wållberg-Jonsson, Solveig

AU - Innala, Lena

AU - Karpouzas, George

AU - Dessein, Patrick H.

AU - Tsang, Linda

AU - El-Gabalawy, Hani

AU - Hitchon, Carol

AU - Ramos, Virginia Pascual

AU - Yáñez, Irazä Contreras

AU - Sfkakis, Petros P.

AU - Zampeli, Evangelia

AU - Gonzalez-Gay, Miguel A.

AU - Corrales, Alfonso

AU - Van De Laar, Mart

AU - Vonkeman, Harald E.

AU - Meek, Inger

AU - Semb, Anne Grete

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives P atients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA. Methods In 13 rheumatology centres, data on CVD risk factors and RA characteristics were collected at baseline. CVD outcomes (myocardial infarction, angina, revascularisation, stroke, peripheral vascular disease and CVD death) were collected using standardised definitions. Results 5638 patients with RA and no prior CVD were included (mean age: 55.3 (SD: 14.0) years, 76% women). During mean follow-up of 5.8 (SD: 4.4) years, 148 men and 241 women developed a CVD event (10-year cumulative incidence 20.9% and 11.1%, respectively). Men had a higher burden of CVD risk factors, including increased blood pressure, higher total cholesterol and smoking prevalence than women (all p<0.001). Among the traditional CVD risk factors, smoking and hypertension had the highest population attributable risk (PAR) overall and among both sexes, followed by total cholesterol. The PAR for Disease Activity Score and for seropositivity were comparable in magnitude to the PAR for lipids. A total of 70% of CVD events were attributable to all CVD risk factors and RA characteristics combined (separately 49% CVD risk factors and 30% RA characteristics). Conclusions In a large, international cohort of patients with RA, 30% of CVD events were attributable to RA characteristics. This finding indicates that RA characteristics play an important role in efforts to reduce CVD risk among patients with RA.

AB - Objectives P atients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA. Methods In 13 rheumatology centres, data on CVD risk factors and RA characteristics were collected at baseline. CVD outcomes (myocardial infarction, angina, revascularisation, stroke, peripheral vascular disease and CVD death) were collected using standardised definitions. Results 5638 patients with RA and no prior CVD were included (mean age: 55.3 (SD: 14.0) years, 76% women). During mean follow-up of 5.8 (SD: 4.4) years, 148 men and 241 women developed a CVD event (10-year cumulative incidence 20.9% and 11.1%, respectively). Men had a higher burden of CVD risk factors, including increased blood pressure, higher total cholesterol and smoking prevalence than women (all p<0.001). Among the traditional CVD risk factors, smoking and hypertension had the highest population attributable risk (PAR) overall and among both sexes, followed by total cholesterol. The PAR for Disease Activity Score and for seropositivity were comparable in magnitude to the PAR for lipids. A total of 70% of CVD events were attributable to all CVD risk factors and RA characteristics combined (separately 49% CVD risk factors and 30% RA characteristics). Conclusions In a large, international cohort of patients with RA, 30% of CVD events were attributable to RA characteristics. This finding indicates that RA characteristics play an important role in efforts to reduce CVD risk among patients with RA.

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