The risk of cardiovascular disease in people with rheumatoid arthritis is just as high as the risk in people with type 2 diabetes, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Francisco, Calif.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

Several studies have concluded that people with RA are at an increased risk for cardiovascular disease. However, these studies have not directly examined the frequency of cardiovascular disease in people with RA compared to and people with type 2 diabetes over time.

Researchers examined the frequency of fatal and nonfatal cardiovascular disease in 335 RA patients followed for three years compared to 1,852 people in the general population.

They found that cardiovascular disease occurred in nine percent of patients with RA and among 4.3 percent of the general population, which corresponded with an incidence of 3.30 people per 100 people per year for those with RA, and 1.51 people per 100 people per year for those in the general population.

Compared to those in the general population, patients with type 2 diabetes and non-diabetic patients with RA have similar risk ratios for developing cardiovascular disease (2.02 and 2.22, respectively), leading researchers to conclude that not only is the risk of cardiovascular disease significantly elevated among people with RA when compared to the general population, but it equals that of people with type 2 diabetes.

“This investigation reveals that the cardiovascular risk in RA equals that of type 2 diabetes, a well established cardiovascular risk factor for which cardiovascular risk management is mandatory,” explains Michael T. Nurmohamed, MD, PhD; rheumatologist and epidemiologist; VU University Medical Center, departments of internal medicine and rheumatology; Jan van Breemen Institute, department of rheumatology, Amsterdam, The Netherlands. “Hence, cardiovascular risk management is also necessary for RA.”

The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases. For more information on the ACR’s annual meeting, see http://www.rheumatology.org/annual.

Editor’s Notes: Dr. Nurmohamed and Mike J. Peters, MD will present this research during the ACR Annual Scientific Meeting at the Moscone Center from 4:45 – 5:00 PM on Sunday, October 26, in Room 304. Dr. Nurmohamed will be available for media questions and briefing at 8:30 AM on Sunday, October 26 in the on-site press conference room, 114.

Presentation Number: 691

Rheumatoid Arthritis As Important Independent Risk Factor For Incident Cardiovascular Disease

Mike J. Peters1, Vokko P. van Halm1, Alexandre E. Voskuyl1, Maarten Boers1, Willem F. Lems1, Marjolein Visser1, Coen DA Stehouwer2, Jacqueline M. Dekker1, Giel Nijpels1, Lex M. Bouter1, Yvo M. Smulders1, Ben AC Dijkmans1, Michael T. Nurmohamed1. 1VU University Medical Center, amsterdam, Netherlands; 2University Hospital Maastricht, Maastricht, Netherlands

Purpose:
Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD), and the magnitude of this risk appears to be comparable to that of type 2 diabetes (DM2). These findings, however, have mostly been ascertained by cross-sectional studies, and longitudinal observations are limited. We therefore compared the incidence of CVD in RA and in DM2 patients with the general population.

Methods:
In the ‘CARRÉ’ study, a prospective cohort which randomly included 335 outpatients with RA, 3-year incident CVD was determined. This incidence was compared to the 3-year incidence of CVD in 1852 participants of a population-based cohort study, the ‘Hoorn’ study. Fatal and non-fatal CVD according to ICD-9 criteria were objectively assessed and cox proportional hazards models were used to compare the incidence of cardiovascular events in RA, DM2 and the general population.

Results:
Incident CVD was reported in 9.0% of the RA patients and in 4.3% of the general population, corresponding with an incidence of 3.30 per 100 patient/years (95%-CI: 1.98-4.30) for RA patients, and 1.51 per 100 person/years (95%-CI: 1.18-1.84) for the general population. Compared to the general population, the age- and gender-adjusted relative risk was 2.00 (95%-CI: 1.25-3.07, p = 0.003) for RA patients. Adjustment for cardiovascular risk factors did not influence this risk. Compared to healthy subjects, DM2 patients and non-diabetic RA patients had similar risk ratios: 2.02 (95%-CI: 1.11-3.66, p = 0.021) and 2.22 (95%-CI: 1.33-3.71, p = 0.002), respectively.

Conclusions:
The risk of CVD in RA is significantly elevated compared to the general population. The elevated risk was not explained by traditional cardiovascular risk factors, and equals the CVD risk in DM2. Hence, RA itself should be considered an important cardiovascular risk factor.

Disclosure Block: M.J. Peters, None; V.P. van Halm, None; A.E. Voskuyl, None; M. Boers, None; W.F. Lems, None; M. Visser, None; C.D. Stehouwer, None; J.M. Dekker, None; G. Nijpels, None; L.M. Bouter, None; Y.M. Smulders, None; B.A. Dijkmans, None; M.T. Nurmohamed, None.

Source: American College of Rheumatology (ACR)