Is Rheumatoid Arthritis a Cardiovascular Risk‐Equivalent to Diabetes Mellitus?

Curtis, Jeffrey R.; Yang, Shuo; Singh, Jasvinder A.; Xie, Fenglong; Chen, Lang; Yun, Huifeng; Muntner, Paul; Kent, Shia T.; Levitan, Emily B.; Safford, Monika M.; Zhang, Jie

doi:10.1002/acr.23535

Cited by 19 publications

(15 citation statements)

References 20 publications

(30 reference statements)

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“…A nationwide Danish study reported that the risk of myocardial infarction was comparable for diabetes and RA patients, with adjusted incidence rate ratios of 1.7 for both groups 3 . A large study from the US found that the risks of CVD were increased in both groups, although diabetes patients had a significantly greater risk than RA patients 14 . However, the magnitude, nature and consequence of a myocardial infarction may differ between the groups.…”

Section: Discussionmentioning

confidence: 98%

Mortality is increased in patients with rheumatoid arthritis or diabetes compared to the general population – the Nord-Trøndelag Health Study

Houge

Thomas

Videm

2020

Sci Rep

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persons with rheumatoid arthritis (RA) or diabetes have increased risk of cardiovascular disease (cVD) and higher death rates compared to the general population. this study used data from the populationbased nord-trøndelag Health Study (HUnt) and the norwegian cause of Death registry to compare all-cause mortality rates for RA or diabetes patients to the general population. We used cox regression with age as time variable, adjusting for sex, smoking, body mass index, hypertension, total cholesterol, creatinine and previous cVD. to achieve proportional hazards, an interaction term with an age group variable (≤75 years or >75 years) was included for diabetes, smoking and previous CVD. Median follow-up was 18.1 years. Mortality occurred for 123 (32%) of the RA patients, 1,280 (44%) of the diabetes patients, 17 (52%) of the patients with both diseases and 11,641 (18%) of the controls. Both diseases were associated with statistically significantly increased mortality rates. The hazard ratio (HR) for RA was 1.24 (95% CI: 1.03-1.44). The HR of diabetes was 1.82 (1.60-2.04) for individuals ≤75 years old and 1.49 (1.39-1.59) for individuals >75 years. Diabetes had a significantly higher HR for death than RA for participants ≤75 years, but not significantly different for participants >75 years. Rheumatoid arthritis (RA) is a systemic inflammatory disease causing inflammation in the synovia. It may lead to joint destruction and extra-articular manifestations such as pericarditis, vasculitis, osteoporosis, rheumatoid nodules and Sjögren's syndrome 1. RA patients have increased risk of cardiovascular events, as well as have higher cardiovascular, respiratory, and all-cause mortality rates compared to the general population 2-10. The risk of cardiovascular disease (CVD) associated with RA has been compared to that of diabetes, a well-known risk factor for CVD and premature death 11-13. Recent evidence indicates that patients with either disease have increased risk of CVD compared to the general population, however, RA was associated with a lower increase in risk than diabetes 14. This somewhat contradicts earlier studies indicating comparable risk in the two groups, and might be explained by changes in treatment of RA and differences in study populations 3,15,16. In the past decades, the general population in the developed world has become healthier and lives longer 17-19. This trend also seems to apply to patients with diabetes 20. However, for RA patients the results over time are more conflicting, from widening mortality gap to better survival than the general population 2,4,5,7,21-28. These contradictory findings might be explained by differences in genetics, demographics and health as well as differences in inclusion of incident or prevalent cases, in RA definition, and in follow-up time. However, most evidence based on large numbers of patients and long observation periods points towards lower absolute mortality rates among RA patients in recent years, though still higher than in the general population 4,5,7,24-26. All-c...

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Section: Discussionmentioning

confidence: 98%

Mortality is increased in patients with rheumatoid arthritis or diabetes compared to the general population – the Nord-Trøndelag Health Study

Houge

Thomas

Videm

2020

Sci Rep

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“…Studies have shown that RA patients have a higher CVD risk compared with the general population 5,16 and the increased CVD risk cannot be explained by traditional CVD risk factors. 17,18 Although increased inflammation in RA is thought to be an independent risk factor for atherosclerotic plaque development, the relationship between inflammation and plaque development has not been elucidated.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of dysfunctional high‐density lipoprotein levels with myeloperoxidase/paraoxonase‐1 ratio in rheumatoid arthritis

Alışık

Nacır

et al. 2021

Int J Clin Pract

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Background:The aim of this study is to evaluate dysfunctional high-density lipoprotein cholesterol (HDL) by measuring myeloperoxidase (MPO)/paraoxonase 1 (PON1) ratio in patients with rheumatoid arthritis (RA) and to investigate the relationship between dysfunctional HDL and cardiovascular disease (CVD) in RA patients.Methods: Sixty-seven healthy individuals and 130 RA patients were included in the study. Routine lipid panels (triglyceride (TG), low-density lipoprotein cholesterol (LDL), HDL, total cholesterol (TC), PON1 and MPO levels were measured. Disease activity scores-28 (DAS28) of RA patients were calculated. Cardiological examination records of the patients were assessed to detect patients who also have CVD.Results: There were no significant differences between RA and control groups in routine lipid profiles (P > .05 for all). MPO/PON1 ratios were significantly elevated in the RA group compared with the control group (P < .001). MPO/PON1 ratios were higher in RA patients with CVD history compared with those without CVD (P < .05).MPO/PON1 ratios were correlated with DAS28 scores (rho: 0.357, P < .001). Conclusion:HDL dysfunction determined by the MPO/PON1 ratio may be associated with the pathophysiology of increased CVD in RA. Thus, evaluating dysfunctional HDL levels by measuring the MPO/PON1 ratio in RA patients may allow more detailed patient follow-up, as well as the reduction of CVD events in RA patients with therapeutic agents aiming to increase the functional properties of HDL by decreasing this ratio.

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“…It is well known that risk of development of cardiovascular disease (CVD) and especially coronary artery disease (CAD) is increased in patients with rheumatoid arthritis (RA) [1]. Data from previous studies showed double fold elevation in the risk of development of heart failure (HF) in RA patients [2].…”

Section: Introductionmentioning

confidence: 99%

2-D speckle-tracking assessment of left and right ventricular function in rheumatoid arthritis patients with and without disease activity

Naseem¹,

Samir²,

Ibrahim³

et al. 2019

Journal of the Saudi Heart Association

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ObjectivesDisease activity has been considered as independent cardiovascular risk factor in rheumatoid arthritis (RA) patients. We aimed to evaluate the effect of RA disease activity on left ventricular (LV) and right ventricular (RV) functions by speckle tracking echocardiography (STE).Methods120 patients with RA without evidence of cardiovascular disease and 40 healthy control subjects were included. Disease activity was evaluated according to Simplified Disease Activity Index (SDAI) score and Disease Activity Score 28 (DAS28). LV and RV functions were assessed using conventional echocardiography and global longitudinal strain (GLS) technique measured by STE.Results81 patients had active disease while 39 patients were in remission. The LV and RV GLS value for active RA patients was reduced compared to RA patients in remission and control group (p = <0.001). There was a significant correlation between RA disease activity scores level and LV GLS value, increasing levels of disease activity was associated with worse LV GLS (r = −0.802, p value = <0.001) and r = −0.824, p value = <0.001) for SDAI and DAS28 scores respectively. Also, there were significant correlations between RA disease activity scores level and RV GLS value as the disease activity level increases the RV GLS value become worse (r = −0.682, p value = <0.001) and r = −0.731, p value = <0.001) for SDAI and DAS28 scores respectively Receiver operating characteristic (ROC) curve analysis showed that SDAI score and DAS28 were predictive for reduced LV GLS with a cut off value of >7 and >2.8 respectively with sensitivity of 77.6%, specificity of 85.0% and area under ROC curve = 90.4 for SDAI score and with sensitivity of 89.7%, specificity of 71.7% and area under ROC curve = 89.4 for DAS28 score. Also, SDAI score and DAS28 were predictive for reduced RV GLS with a cut off value of >11 and >3 respectively with sensitivity of 73.1%, specificity of 93.5% and area under ROC curve = 91.6 for SDAI score and with sensitivity of 84.6%, specificity of 80.4% and area under ROC curve = 90.8 for DAS28 score.ConclusionDisease activity in patients with rheumatoid arthritis is associated with lower left and right ventricular function. Disease activity scores can predict subclinical left and right ventricular dysfunction.

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Is Rheumatoid Arthritis a Cardiovascular Risk‐Equivalent to Diabetes Mellitus?

Cited by 19 publications

References 20 publications

Mortality is increased in patients with rheumatoid arthritis or diabetes compared to the general population – the Nord-Trøndelag Health Study

Mortality is increased in patients with rheumatoid arthritis or diabetes compared to the general population – the Nord-Trøndelag Health Study

Evaluation of dysfunctional high‐density lipoprotein levels with myeloperoxidase/paraoxonase‐1 ratio in rheumatoid arthritis

2-D speckle-tracking assessment of left and right ventricular function in rheumatoid arthritis patients with and without disease activity

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