AB0331 Incidence and Predictors of Cardiovascular Events Over a Period of 5 Years in a Cohort of Women with Rheumatoid Arthritis: Table 1.

Abstract

BackgroundAn excess in cardiovascular (CV) morbidity and mortality has been recognized in Rheumatoid Arthritis (RA) patients when compared to the general population.ObjectivesOur aim was to estimate the incidence of CV events and the contribution of traditional CVD risk factors and RA-related parameters to future events.MethodsIncident fatal and non-fatal CV events (hospitalizations due to unstable angina, myocardial infarction, coronary artery revascularization procedures, stroke, or CV death) were assessed in a prospective cohort of RA women followed since 2007 and without CV events at cohort entry. The presence of traditional CV risk factors, disease characteristics, medication, carotid ultrasound, and biomarkers of inflammation and endothelial activation were evaluated at baseline. Univariate Cox proportional hazard models were used to identify risk factors for CV events.ResultsAmong 106 women followed over 565 patient-years we identified 4 CV events (1 fatal stroke, 2 myocardial infarction and 1 unstable angina), which contributed to an incidence rate of 7 per 1000 person-years (95%CI 2.0-13.9). Patients who developed CV events were older, but the distribution of other traditional CV risk factors was otherwise similar in both groups. Also, corticosteroid dosage and proportion of patients with carotid atherosclerotic plaques was higher in those with CV events (Table 1). Erythrocyte sedimentation rate (ESR) (HR 1.036; 95%CI 1.005-1.067) and soluble intercellular adhesion molecule-1 (sICAM-1) serum levels (HR 1.002; 95%CI 1.000-1.003) significantly contributed to CV events. These results remained significant after adjusting for patients' age.Table 1.Baseline characteristics of RA women with and without CV eventsWith CV event (n=4)Without CV event (n=102)Age, years63.5±4.249,3±13.9Caucasians (%)3 (75%)91 (89.2%)RA duration6.57±7.139.80±7.35RF positive (%)4 (100%)75 (73.5%)Mean DAS 284.34±1.304.17±1.31Mean HAQ1.5±0.891.10±0.70Corticosteroids dose at baseline, mg6.25±4.792.93±3.2Smokers (%)1 (25)17 (16.7)Hypertension (%)2 (50)69 (67.6)Dyslipidemia (%)1 (25)20 (19.6)Diabetes (%)05 (4.9)Obesity (BMI>30)2 (50)31 (30.4)Atherosclerotic carotid plaques (n=61)2 (50)7 (12.3)ESR, mm/h66.25±30.8436.43±23.01sVCAM1 ng/ml1034.92±458.491147.20±450.33sICAM1 ng/ml1226.69±568.25637.88±418.07ConclusionsWe found an incidence of cardiovascular events in women with RA of 7 per 1000 patent-years. This value is similar to that found in other Portuguese cohort of RA patients1 and much higher than the incidence reported for the general Portuguese population. Markers of inflammation and endothelial activation contributed significantly to CV events, but the limited number of events prevents further analysis.ReferencesSantos MJ, et al. The incidence of cardiovascular events among rheumatoid arthritis patients in Portugal. Ann Rheum Dis 2009;68 (Suppl3):406Disclosure of InterestNone declared

Accelerated atherosclerosis in premenopausal women with rheumatoid arthritis – 15-year follow-up

“…Higher levels were found to increased cardiovascular mortality rate and predicted future events [34]. Furthermore, Castro et al stated that ESR and ICAM seem to be independent predictor of cardiovascular events [24]. We found significantly elevated levels of ICAM in RA patients, but we found no correlation between ICAM and asympthomatic atherosclerosis in RA patients.…”

“…The clinical relevance of our findings is even more important if we consider that the previously published studies showed that the risk of acute myocardial infarction increases for 43% for every 0.163 mm increase in cIMT and that the prevalence of carotid plaque is even a more reliable predictor of cardiovascular events [1,13,[24][25][26][27]. Recent study of Corrales et al [28] also showed that the presence of carotid plaques predicted the development of CV events and death in RA patients.…”

“…The clinical relevance of these findings is even more important in consideration of previous studies, which reported that the risk of acute myocardial infarction increases by 43% for every 0.163-mm increase in cIMT and that the prevalence of carotid plaque is an even more reliable predictor of CV events [ 1 , 13 , 24 - 27 ]. A recent 5-year-prospective follow-up study conducted by Corrales et al [ 28 ] of 327 RA patients reported that 23 (7.0%) had died and 27 (8.3%) had experienced CV events, indicating that the presence of carotid plaques was predictive of the development of CV events and death in RA patients.…”

“…Santos et al [ 34 ] suggested that circulating VCAM levels might be predictive of CV disease, as higher levels were found to increase CV-associated mortality and were predictive of future CV events. Furthermore, Castro et al [ 24 ] proposed ESR and ICAM as independent predictors of CV events. In the present study, ICAM levels were significantly elevated in RA patients, but there was no correlation between ICAM levels and asymptomatic atherosclerosis in RA patients.…”

Incidence Rate of Cardiovascular Events in Rheumatoid Arthritis: An Observational Cohort Study in Saudi Arabia

“… 23 Similarly, a Portuguese cohort of RA women reported a rate of 7 per 1000 person-years. 24 In England, the incidence rate was 35.33 per 1000 person-years, using a broader definition of CVD that included twelve different presentations. 25 Note that all rates were standardized to per 1000 person-years for comparison.…”