Results of a study published in the April 15th issue of the American Journal of Cardiology indicate that men older than 50 years of age with rheumatoid arthritis have an increased risk of major adverse cardiovascular events. The rheumatoid arthritis disease activity score predicts these events independent of traditional cardiovascular risk factors in this population.
"In men with rheumatoid arthritis (RA), the confounding effect of adverse cardiovascular risk profile on the independent association of RA disease activity score (DAS) and major adverse cardiovascular events (MACEs) continues to be debated," write Dr. Subhash Banerjee, of the University of Texas Southwestern Medical Center, Dallas, and colleagues.
The researchers used data from the prospective Veterans Affairs Rheumatoid Arthritis Registry to examine the association between RA DAS and MACE rates.
Major adverse cardiovascular events were defined as acute coronary syndromes, coronary revascularization using percutaneous coronary intervention or coronary artery bypass grafting, new-onset heart failure, stroke, and death. The investigators categorized DAS as low (0 to 3.2), moderate (3.2 to 5.09), and high (5.1 or higher).
A total of 282 men were included in the study, and 231 of them (82 per cent) had a valid DAS. Overall, 92 subjects (32.6 per cent) experienced a MACE during a mean follow-up of 4.4 years.
The team found that 54 per cent of patients with high disease activity had cardiovascular events, compared to 26 per cent of those with low disease activity (p = 0.02). Patients with high disease activity had a lower mean event-free period compared to those with low or moderate disease activity (19 years versus 35 and 30 years, respectively; p = 0.03).
"Cox proportional hazards analysis indicated that DAS was a significant predictor of CV events (hazard ratio 1.31, p = 0.01) independent of such traditional risk factors as age, gender, diabetes, tobacco use, hypertension, hyperlipidemia, and history of vascular disease," Dr. Banerjee and colleagues report.
Based on these findings and others, the researchers conclude that "it is possible to speculate that early aggressive control of chronic inflammation and primary and secondary modification of traditional CV risk factors in patients with RA may result in improved survival and lower CV event rates."