POS0589 CARDIOVASCULAR DISEASE RISK IN INFLAMMATORY ARTHRITIS STILL ELEVATED IN 2021!

Abstract

BackgroundPatients with inflammatory rheumatic diseases as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and spondyloarthritis (SpA) are at higher risk for developing cardiovascular diseases (CVD) than the general population. This is due to a higher prevalence of ‘traditional’ CV risk factors as hypertension and dyslipidemia, and the underlying systemic inflammation. During the past two decades, the burden of inflammation has been reduced by more efficacious anti-rheumatic treatment, leading to a reduced CVD risk, albeit still elevated in comparison to the general population. Therefore, it remains important to monitor the presence of CVD in rheumatic patients in systematically controlled cohorts.ObjectivesTo evaluate whether, nowadays, the CVD risk of patients with inflammatory rheumatic diseases still differs from the general population.MethodsIn March 2020, all adult patients with an inflammatory rheumatic disease from the Amsterdam Rheumatology and Immunology Center, location “Reade” were systematically asked to participate in a prospective cohort study, which focused on the impact of the COVID-19 pandemic. The patients were compared with age and sex matched controls. In the third questionnaire, sent out in January 2021, questions regarding CV risk factors and comorbidities were added. Baseline characteristics and prevalence of CV risk factors and CVD were compared between RA, PsA or SpA patients, and healthy controls.Results2050 consecutive patients with an inflammatory rheumatic disease (1312 RA patients, 353 PsA patients, 385 SpA patients), and 939 healthy controls completed the questionnaires (Table 1). The prevalence of at least one CV comorbidity was more frequently reported in RA, PsA and SpA patients compared to healthy controls: 69 (5%), 24 (7%), 17 (4%) compared to 31 (3%), respectively. Events were primarily cardiac (i.e. myocardial infarction and coronary angioplasty). Inflammatory arthritis patients more often had hypertension or hypercholesterolemia than healthy controls, which were untreated in nearly half the cases. RA patients most often used anticoagulant medication.Table 1.Baseline characteristics. Values are displayed as mean ± standard deviation (SD) or frequencies with percentages (%). RA = rheumatoid arthritis, PsA = psoriatic arthritis, SpA = spondyloarthritis, CV = cardiovascular, DMARD = disease modifying anti-rheumatic drugPatient characteristicsAll patients (n = 2050)RA(n = 1312)PsA(n = 353)SpA(n = 385)Control(n = 939)Mean age – yr57 ± 1360 ± 1257 ± 1251 ± 1355 ± 13Female sex - no (%)1266 (63)923 (70)164 (47)179 (47)636 (69)CV risk factors - no (%)Hypertension746 (37)482 (38)134 (39)130 (34)213 (23) Antihypertensive med411 (20)271 (21)78 (22)62 (16)131 (14)Hypercholesterolemia594 (30)391 (31)102 (30)101 (27)197 (21) Statins335 (16)223 (17)59 (17)53 (14)98 (10)Anticoagulants246 (12)180 (14)34 (10)32 (8)74 (8)CV diseases - no (%)Overall110 (5)69 (5)24 (7)17 (4)31 (3)Cardiac91 (4)60 (5)17 (5)14 (4)26 (3)Cerebral27 (1)12 (1)9 (3)6 (2)4 (0)Peripheral14 (1)10 (1)3 (1)1 (0)3 (0)Anti-rheumatic drugs - no (%)Prednisone202 (10)175 (13)17 (5)10 (3)n/aConventional synthetic DMARD1118 (55)902 (69)184 (52)32 (8)n/aBiological DMARD895 (44)512 (39)166 (47)217 (56)n/aTargeted synthetic DMARD20 (1)11 (1)5 (1)4 (1)n/aConclusionThe prevalence of CVD was approximately 1.5 times higher in patients with inflammatory rheumatic diseases compared to healthy controls (5% vs 3%), similar to older investigations. The prevalence of CV risk factors also remained elevated, and often undertreated. This indicates that the CVD risk in arthritis patients is still elevated in 2021 compared to the general population, despite improved anti-rheumatic treatment. Therefore, adequate and timely treatment of CV risk factors and optimization of anti-rheumatic drug treatment remains important in all inflammatory arthritis patients.