AB0312 CARDIOVASCULAR RISK FACTOR’S BEHAVIOR AND CARDIOVASCULAR RISK IN HISPANIC EARLY RHEUMATOID ARTHRITIS PATIENTS: A COHORT STUDY

Abstract

Background Rheumatoid arthritis (RA) patients present an increased risk of cardiovascular (CV) morbidity and mortality compared to the general population1. Patients from Latin-America exhibit younger age, female preponderance, less severe disease and dyslipidemia, which are relevant when assessing CV risk2. In order to impact CV morbidity/mortality, control of reversible CV-risk factors need to be achieved3. Cohorts allow prospective evaluation of long-term outcomes. In 2004 we initiated an early RA cohort. Up to June 2018, the cohort comprised 185 RA patients with prospective assessments of CV risk and at least one year of follow-up. Objectives To monitor CV risk-factor’s behavior during the first year of follow-up and to identify if traditional CV risk scores predict major CV events (MACE) in our population. Methods Once enrolled patients had complete rheumatic evaluations at regular intervals. Baseline CV-risk factor’s assessments included age, gender, ethnicity, physical activity and history of first-degree relatives with premature heart disease. CV-risk factors assessments at baseline and at least 6 months apart included blood pressure, serum total cholesterol (CHO) and HDL cholesterol (Castelli ratio CHO/HDL was derived), serum glucose (GLU, in mg/dL), body mass index (BMI), CRP (in mg/dL) and (at least) the following comorbidities: Hypertension (HT, and HT treatment), diabetes mellitus (DM), advanced chronic kidney failure (CKF) and atrial fibrillation (AF). Smoking status was assessed at baseline and last follow-up. Incident MACE were defined according to standard definitions4. Cox regression’s model identified predictors of incidental MACE. Patients gave written informed consent. Results At cohort entry, the 185 patients (all Hispanic) which data were analyzed were primarily middle-aged females (87.6%) and had 5.3 months (3.3-7.1) of disease duration. Most prevalent CV risk factors were CRP >1 mg/dL (90%), Castelli ratio > 3 (84%) and low HDL levels (74%). During the first year of follow-up, smoking status, systolic blood pressure ≥ 140 mm Hg, diastolic blood pressure ≥ 90 mm Hg, low HDL, Castelli ratio > 3, high CRP and patients with active disease progressively decreased; meanwhile, the opposite figure was true for BMI ≥ 30 kg/m2 and patients on corticosteroids. At 12 months of follow-up, number of patients with incident CV risk factor was higher for Castelli-ratio > 3 (23%), low HDL (16.3%), high CHO (10.6%), BMI ≥ 30kg/m2 (10%), CRP >1 mg/dL (7.5%) and age ≥45 years old (3.3%). During the first year of follow-up, 45.8% of the patients had age between 40-79 years old, required to apply American Heart Association (AHA) criteria; these identified 12 patients with high CV-risk. Up to June 2018, the cohort had 1358 patient/years follow-up and 6 patients had incidental MACE after (median, IQR) 6.5 years of follow-up (3.3-9.5). High CV-risk score at baseline failed to predict incidental MACE. Meanwhile, BMI ≥30kg/m2 was a predictor of incidental MACE in our population. Conclusion Hispanic RA patients from an early RA cohort present a distinctive pattern of CV risk factors. Due to younger age at RA presentation, a minority of the patients had CV risk scored. Obesity was a predictor of incidental MACE in our population.