Does rheumatoid arthritis equal diabetes mellitus as an independent risk factor for cardiovascular disease? A prospective study

Abstract

Objective. Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD), but longitudinal observations are limited and the precise magnitude is unknown. We prospectively assessed the incidence of CVD in patients with RA compared with patients with type 2 diabetes mellitus (DM) and the general population. Methods. The 3-year incidence rate of CVD was determined in a prospective cohort (the Cardiovascular Research and Rheumatoid Arthritis Study) of 353 outpatients with RA, and was compared with that in 1,852 population-based cohort study participants (155 had type 2 DM). We investigated fatal and nonfatal CVD (according to International Classification of Diseases, Ninth Revision criteria) and used Cox proportional hazards models to assess the incidence of CVD in RA, type 2 DM, and the general population. Results. The 3-year incidence of CVD was 9.0% in patients with RA and 4.3% in the general population, corresponding with an incidence rate of 3.30 per 100 patient-years (95% confidence interval [95% CI] 2.08 -4.25) and 1.51 per 100 person-years (95% CI 1.18 -1.84), respectively. Compared with the general population, the age-and sex-adjusted hazard ratio (HR) for RA was 1.94 (95% CI 1.24 -3.05, P ‫؍‬ 0.004). Neither exclusion of patients with prior CVD at baseline nor adjustment for cardiovascular risk factors significantly influenced this. Compared with the nondiabetic population, nondiabetic patients with RA and those with type 2 DM had comparable HRs, 2.16 (95% CI 1.28 -3.63, P ‫؍‬ 0.004) and 2.04 (95% CI 1.12-3.67, P ‫؍‬ 0.019), respectively. Conclusion. The risk of CVD in RA was significantly elevated compared with the general population, and comparable with the magnitude of risk in type 2 DM.

Incident Heart Failure in Patients With Rheumatoid Arthritis: A Nationwide Cohort Study

“…In patients with RA, the excess cardiovascular disease risk appears to be comparable with that found in patients with type 2 diabetes mellitus 6, 7. Both conventional cardiovascular risk factors (eg, hypertension, obesity, dyslipidemia, and diabetes mellitus) and increased systemic inflammation play a contributory role 4, 8, 9…”

Relationship between asymmetric dimethylarginine and endothelial dysfunction in patients with rheumatoid arthritis

“…The risk of myocardial infarction is increased 3.1-fold in RA patients who had a time from diagnosis duration of more than 10 years (14). In a study, CVD risk was reported as 13%, 5%, and 12% in nondiabetic patients with RA, the control group, and the diabetic patient group, respectively (15). Therefore, it is important to detect atherosclerosis at an early stage, to identify patients with high risk, and to initiate treatment early.…”

Managing cardiovascular risk in patients with inflammatory arthritis: practical considerations

“…mellitus [Peters et al 2009]. In the Danish nationwide study, the overall incidence rate ratio of myocardial infarction (MI) in RA was estimated at 1.7 [95% confidence interval (CI) 1.5-1.9], which is similar to that observed in diabetes mellitus [Lindhardsen et al 2011].…”