Abstract
BackgroundPrevious studies found increased case fatality after myocardial infarction and more frequent sudden death in RA patients compared to non-RA subjects. The RA associated CV risk might be explained by the combined effects of chronic systemic inflammation and increased lifestyle associated cardiovascular risk factors, and modified by the use of medication such as non steroidal anti-inflammatory drugs, corticosteroids and disease modifying anti-rheumatic drugs. Trends in case fatality rate in RA after the introduction of potent anti-inflammatory biologic therapies and treat-to-target treatment strategies aiming at remission are not known. This study was performed to examine the cardiovascular fatality rate in current low disease activity RA, and to evaluate trends in RA associated CV case fatality over time.MethodsProspective study to determine the incidence of fatal and nonfatal CV events in 480 RA patients included in the ACT-CVD cohort between February 2009 and December 2011. Patients with prior CV disease were excluded. Cox regression analysis was performed to determine CV event risk and contributing risk factors over time. The results of the cohort analysis were put into the context of a review of the literature to evaluate trends in RA associated CV fatality rate over time.ResultsThe study included 480 RA patients, 72.3% female with median disease duration of 4.2 years, 72.1% being in clinical remission (Disease Activity Score in 28 joints). During a mean follow up of 2.9 years 29 patients (6%) experienced a first CV event, 2 fatal and 27 non-fatal, corresponding to a 6.9% case fatality rate. Comparison with previous studies in cohorts with successive enrolment periods shows a trend towards a decrease in CV case fatality in RA from 52.9% in 1998 to 6.9% in our study.ConclusionCV case fatality in current low disease activity RA is importantly lower than in previous studies, and a trend towards decreasing CV fatality in RA is suggested.
Highlights
Previous studies found increased case fatality after myocardial infarction and more frequent sudden death in Rheumatoid arthritis (RA) patients compared to non-RA subjects
CV disease in RA is more severe and associated with a worse prognosis, which was shown by studies in RA cohorts with enrollment in the 1990s that found significantly increased 30-day mortality after myocardial infarction and more frequent sudden death compared to non-RA patients [8,9]
Analyses of time trends in RA associated CV events show conflicting results and recent studies show increased CV events in RA patients compared to the general population [6,11,12]
Summary
Previous studies found increased case fatality after myocardial infarction and more frequent sudden death in RA patients compared to non-RA subjects. This study was performed to examine the cardiovascular fatality rate in current low disease activity RA, and to evaluate trends in RA associated CV case fatality over time. CV disease in RA is more severe and associated with a worse prognosis, which was shown by studies in RA cohorts with enrollment in the 1990s that found significantly increased 30-day mortality after myocardial infarction and more frequent sudden death compared to non-RA patients [8,9]. Analyses of time trends in RA associated CV events show conflicting results and recent studies show increased CV events in RA patients compared to the general population [6,11,12]
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