Risk of Major Adverse Cardiovascular Events in Patients With Rheumatoid Arthritis

Mal, Kheraj; Kumar, Ratan; Mansoor, Farah; Kaur, Navneet; Kumar, Anil; Memon, Sidra; Rizwan, Amber

doi:10.7759/cureus.12246

Cited by 6 publications

(3 citation statements)

References 24 publications

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“…No major changes were observed after introducing the various RA treatments, except in TKR after cDMARD treatment was made available, but the slope remained stable after bDMARD treatment. Studies have reported high risks of GI bleeding, MACE, OVT, TB, joint replacement, cancer, and mortality in patients with RA 5,23‐29 . Our study determined that incidence rates of GI bleeding, MACE, cancer, and mortality among patients with RA were similar to those in clinical trial studies and meta‐analyses 11,30 .…”

Section: Discussionsupporting

confidence: 57%

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Trends of adverse events and mortality after DMARDs in patients with rheumatoid arthritis: Interrupted time‐series analysis

Fang

Liu

Chang

et al. 2022

Immunity Inflam & Disease

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Objectives Patients with rheumatoid arthritis (RA) experience adverse events because of the characteristics of the disease and the side effects of medications. We investigated the trends of adverse events and mortality associated with disease‐modifying antirheumatic drugs (DMARDs). Methods We used the Taiwan National Health Insurance Database to enroll patients with incident RA between 2000 and 2017. The 1‐year incident rate of gastrointestinal (GI) bleeding and 3‐year incident rates of other adverse events and mortality for each calendar‐quarter cohort were computed and adjusted using propensity score‐based stabilized weights for fair comparisons. Levels and trends of the conventional DMARD era (2000–2002, Phase 1) were compared with those of the TNFi era (2003–2012, Phase 2) and OMA era (2013–2017, Phase 3) by using interrupted time series (ITS) analysis. Results All patients with RA were prescribed cDMARDs in Phase 1 (2000–2002), and 1%–3% were prescribed either TNFi in phase 2 (2003–2012) or OMAs in phase 3 (2013–2017). The cancer incidence rate was 1.90%, and its mortality rate was 4.19%. After the introduction of TNFi from 2003 to 2012, the main outcomes, except TKA, exhibited a steady or mild decrease in trends. ITS analysis revealed that the slope mildly increased in 2003–2012 compared with that in 2000–2003 by 0.13% for total knee replacement (p = .0322). In 2012–2017 (the OMA era), the events became steady. Conclusion In patients with RA, the introduction of DMARDs was associated with stable adverse events and mortality rates. Moreover, the introduced new treatment for RA exhibited a good safety profile.

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Section: Discussionsupporting

confidence: 57%

“…and mortality in patients with RA. 5,[23][24][25][26][27][28][29] Our study determined that incidence rates of GI bleeding, MACE, cancer, and mortality among patients with RA were similar to those in clinical trial studies and metaanalyses. 11,30 We consider GI bleeding to decrease after cDMARDs and bDMARDs treatment.…”

Section: Cancer and All-cause Mortalitymentioning

confidence: 86%

Trends of adverse events and mortality after DMARDs in patients with rheumatoid arthritis: Interrupted time‐series analysis

Fang

Liu

Chang

et al. 2022

Immunity Inflam & Disease

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“…Rheumatoid arthritis (RA) is a systemic autoimmune disease, the pathogenic basis of which involves a complex interaction of factors leading to chronic synovial inflammation, joint damage and deformation [1]. In addition to synovitis, RA patients are at high risk of cardiovascular diseases (CVDs) [2][3][4]. The risk of developing CVD in RA patients is 50% higher as compared to the general population [1].…”

Section: Introductionmentioning

confidence: 99%

Von Willebrand Factor and Intima-Media Thickness in Patients With Rheumatoid Arthritis: A Cross-Sectional Study

Fedorovych

Yatsyshyn²

2023

Galician med. j.

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Background. Cardiovascular risk assessment in patients with rheumatoid arthritis (RA) is often a real challenge and requires the search for new indicators to reveal the potential threat of developing atherosclerotic vascular lesions in the early stages. The study aimed to analyse the association between von Willebrand factor (vWF), disease activity, and intima-media thickness (IMT) score in RA patients. Materials and Methods. The study involved 60 RA patients divided into three groups based on the Disease Activity Score 28 (DAS-28) activity index and 20 individuals as healthy controls. Clinical and laboratory assessments included determining the number of swollen (SJ) and painful joints (PJ), the visual analogue scale (VAS) score, the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and fibrinogen. The concentration of vWF in blood plasma was determined by an enzyme-linked immunosorbent assay (ELISA). The IMT was measured at the bifurcation of the external and internal carotid arteries. Asymptomatic vascular damage was identified as the IMT > 0.9 mm; an atherosclerotic plaque was verified when a focal structure encroached ≥ 0.5 mm or 50% of the adjacent IMT value into the carotid lumen or the IMT > 1.5 mm. Results. Most RA patients (39/60; 65.0%) showed an increase in the IMT (> 0.9 mm); atherosclerotic plaques (IMT > 1.5 mm) were confirmed in 16 (26.7%) individuals, which was significantly more as compared to the control group. VWF was positively associated with the IMT [OR 1.1 (1.06-1.2), p < 0.001]. In addition, elevated levels of vWF were associated with disease activity. The highest values of vWF were found in patients with moderate RA activity (43.3 [21.2-56.9]). There was a positive correlation between vWF and ESR, CRP, DAS-28 (0.564, 0.455, and 0.573, respectively). Conclusions. There was a positive correlation between vWF, inflammatory markers, and disease activity. VWF appeared to be a reliable predictor of the IMT score in RA patients.

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Endothelial dysfunction and risk factors for atherosclerosis in psoriatic arthritis: overview and comparison with rheumatoid arthritis

Kaleta,

Krupa,

Suchy

et al. 2024

Rheumatol Int

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Endothelial dysfunction (ED) is defined as an impairment in the vasodilatory, anti-thrombotic, and anti-inflammatory properties of the cells that make up the lining of blood vessels. ED is considered a key step in the development of atherosclerotic cardiovascular disease. The association between ED and systemic inflammatory diseases is well established. However, the prevalence and clinical significance of ED in psoriatic arthritis (PsA) have been investigated to a lesser extent. This review aims to explore the link between ED and PsA, including ED in macro- and microcirculation, as well as risk factors for its occurrence in PsA and its relationship with atherosclerosis in PsA. Furthermore, the ED in PsA was compared with that of rheumatoid arthritis (RA). Regarding ED in the microcirculation, the coronary flow reserve was found to be significantly reduced in individuals with PsA. The relationship between PsA and macrovascular ED is more pronounced, along with more advanced atherosclerosis detected in patients with PsA. These results are consistent with those obtained in RA studies. On the other hand, arterial stiffness and signs of vascular remodeling were found more frequently in RA than in PsA, with the potential role of efficient anti-TNF treatment in patients with PsA and psoriasis explaining this finding. The impact of ED on cardiovascular diseases and the burden of this risk caused independently by PsA have not yet been precisely established, however, this group of patients requires special attention with regard to cardiovascular events.

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Risk of Major Adverse Cardiovascular Events in Patients With Rheumatoid Arthritis

Cited by 6 publications

References 24 publications

Trends of adverse events and mortality after DMARDs in patients with rheumatoid arthritis: Interrupted time‐series analysis

Trends of adverse events and mortality after DMARDs in patients with rheumatoid arthritis: Interrupted time‐series analysis

Von Willebrand Factor and Intima-Media Thickness in Patients With Rheumatoid Arthritis: A Cross-Sectional Study

Endothelial dysfunction and risk factors for atherosclerosis in psoriatic arthritis: overview and comparison with rheumatoid arthritis

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