Cardiovascular disease is increased prior to onset of rheumatoid arthritis but not osteoarthritis: the population-based Nord-Trøndelag health study (HUNT)

Helen Pahau,Matthew A Brown,Ranjeny Thomas,Sanjoy Paul,Vibeke Videm

doi:10.1186/ar4527

Abstract

IntroductionPatients with rheumatoid arthritis (RA) have increased risk of cardiovascular (CV) events. We sought to test the hypothesis that due to increased inflammation, CV disease and risk factors are associated with increased risk of future RA development.MethodsThe population-based Nord-Trøndelag health surveys (HUNT) were conducted among the entire adult population of Nord-Trøndelag, Norway. All inhabitants 20 years or older were invited, and information was collected through comprehensive questionnaires, a clinical examination, and blood samples. In a cohort design, data from HUNT2 (1995–1997, baseline) and HUNT3 (2006–2008, follow-up) were obtained to study participants with RA (n = 786) or osteoarthritis (n = 3,586) at HUNT3 alone, in comparison with individuals without RA or osteoarthritis at both times (n = 33,567).ResultsFemale gender, age, smoking, body mass index, and history of previous CV disease were associated with self-reported incident RA (previous CV disease: odds ratio 1.52 (95% confidence interval 1.11-2.07). The findings regarding previous CV disease were confirmed in sensitivity analyses excluding participants with psoriasis (odds ratio (OR) 1.70 (1.23-2.36)) or restricting the analysis to cases with a hospital diagnosis of RA (OR 1.90 (1.10-3.27)) or carriers of the shared epitope (OR 1.76 (1.13-2.74)). History of previous CV disease was not associated with increased risk of osteoarthritis (OR 1.04 (0.86-1.27)).ConclusionA history of previous CV disease was associated with increased risk of incident RA but not osteoarthritis.

Highlights

Patients with rheumatoid arthritis (RA) have increased risk of cardiovascular (CV) events
To represent the CV risk factors in another way, we developed alternative models including the Framingham risk score, which is based on age, serum cholesterol, hypertension, smoking and diabetes [23], as well as gender and history of CV disease
In the present large population-based health study we found that participants who developed RA between HUNT2 and HUNT3 had more CV disease and CV risk factors prior to the onset of RA compared to those without incident RA

Summary

Introduction

Patients with rheumatoid arthritis (RA) have increased risk of cardiovascular (CV) events. We sought to test the hypothesis that due to increased inflammation, CV disease and risk factors are associated with increased risk of future RA development. Inflammation plays a central role in the pathogenesis of atherosclerosis, and the increase in CV disease and mortality in RA may partly be explained by inflammatory factors associated with RA, even after adjustment for traditional CV risk factors [10,11]. The risk for myocardial infarction (MI) and possible CV death is already increased within approximately 5 years after diagnosis of RA depending upon age and presence of CV risk factors, resulting in a 10-year absolute risk comparable to nonRA individuals who were 5 to 10 years older [14]

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