MedWire News: The risk for a patient with rheumatoid arthritis (RA) experiencing a major cardiovascular (CV) event can be significantly lowered with appropriate risk factor management and treatment with disease-modifying anti-rheumatic drugs (DMARDs), say researchers.
"Patients with RA are 30% to 60% more likely to suffer a CV event compared with the general population," Antonio Naranjo (Hospital de Gran Canaria, Spain) and associates comment. Such events occur around a decade earlier in RA patients, they add, with coronary artery and cerebroatherosclerosis often being the major culprits.
Naranjo and team report the results of the Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) Program in the journal Arthritis Research & Therapy. They explain that QUEST-RA involved 4343 patients with RA who were treated at 48 clinical sites in 15 countries.
The prevalence of CV events, including myocardial infarction (MI), angina, coronary artery disease or stroke, ranged from less than 5% in Argentina to more than 10% in Finland, Germany, Poland, the UK, and USA, averaging out at 9.3% across the whole cohort. The lifetime prevalence of MI for the whole cohort was 3.2% and for stroke was 1.9%. Men were more likely than women to experience a CV event.
One third of RA sufferers had hypertension and 14% had hyperlipidemia. Eight per cent had comorbid diabetes and 18% were obese. Just under half (43%) of the patients had smoked at some point in their lives. Although 75% of patients were physically inactive due to their joint disease, this was not associated with CV disease in this study, the researchers comment. Hypertension, hyperlipidemia, older age, male gender, and having ever smoked were associated with CV events.
Treatment with methotrexate for 1 year was associated with a 15% decrease in the risk for CV events, Naranjo and team note, with an 18% decrease in the risk for an MI and an 11% decrease in the risk for stroke. Leflunonmide was also associated with a reduction in CV events, as was treatment with glucocorticoids and sulfasalazine to a lesser, but still significant, extent.
These data further support the idea that prolonged DMARD use can reduce the risk for CV events in patients with RA, the research team states. "Furthermore, extra-articular RA was found to be associated with the occurrence of MI, and the role of traditional risk factors for CV morbidity was confirmed," the authors conclude.
In an accompanying editorial, Ronald van Vollenhoven of Karolinska Institute, Sweden, commented: "The possibility that antirheumatic therapy decreases the risk for cardiovascular complications is tantalizing. The current study, while not exactly proving this point, adds a further measure of support to the concept, and suggests that it must now be formally addressed."
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