Estimated 10-year cardiovascular risk in a large Italian cohort of rheumatoid arthritis patients: Data from the Cardiovascular Obesity and Rheumatic DISease (CORDIS) Study Group

Published:October 14, 2021DOI:https://doi.org/10.1016/j.ejim.2021.10.001

      Highlights

      • The 10-year cardiovascular (CV) risk is 3- to 4-fold higher in rheumatoid arthritis (RA) patients compared to age- and sex-matched osteoarthritis patients.
      • A careful surveillance for CV disease is mandatory for all physicians that manage RA patients applying the “Systematic COronary Risk Evaluation” (SCORE) and the “Progetto Cuore” charts for Italian patients.
      • Refrain from smoking, improve blood pressure and glycaemic levels control and sustained remission or low disease activity, represent the most pertinent CV prevention measures in RA patients.

      Abstract

      Background

      Several cardiovascular (CV) risk algorithms are available to predict CV events in the general population. However, their performance in patients with rheumatoid arthritis (RA) might differ from the general population. This cross-sectional multicentre study aimed to estimate the 10-year CV risk using two different algorithms in a large RA cohort and in patients with osteoarthritis (OA).

      Methods

      In a consecutive series of RA patients and matched OA controls without prior CV events, clinical and serologic data and traditional CV risk factors were recorded. The 10-year CV risk was assessed with the Systematic COronary Risk Evaluation (SCORE) and the “Progetto Cuore” algorithms.

      Results

      1,467 RA patients and 342 OA subjects were included. RA patients were more frequently diabetic (9.9% vs 6.4%; p=0.04) and smokers (20.4% vs 12.5%; p=0.002) but had lower prevalence of obesity (15% vs 21%; p=0.003). Dyslipidaemia was more prevalent in OA (32.5% vs 21.7%; p<0.0001). The 10-year estimated CV risk was 1.6% (95%CI 1.3-1.9) in RA and 1.4% (95%CI 1.3-1.6) in OA (p=0.002) according to SCORE and 6.5% (95%CI 6.1-6.9) in RA and 4.4% (95%CI 3.9-5.1) in OA (p<0.001) according to “Progetto Cuore”. Regardless of the score used, RA patients had a 3- to-4-fold increased 10-year risk of CV events compared to OA subjects.

      Conclusion

      RA patients have a significantly higher 10-year risk of CV events than OA subjects. In addition to effective disease control and joint damage prevention, specific protective measures targeting modifiable traditional CV risk factors should be implemented in RA.

      Keywords

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      References

        • Løgstrup BB
        • Ellingsen T
        • Pedersen AB
        • et al.
        Cardiovascular risk and mortality in rheumatoid arthritis compared with diabetes mellitus and the general population.
        Rheumatology. 2021; 60: 1400-1409
        • Crowson CS
        • Rollefstad S
        • Ikdahl E
        • et al.
        A trans-atlantic cardiovascular consortium for rheumatoid arthritis (ATACC-RA). Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis.
        Ann Rheum Dis. 2018; 77: 48-54
        • López-Mejías R
        • Castañeda S
        • González-Juanatey C
        • et al.
        Cardiovascular risk assessment in patients with rheumatoid arthritis: the relevance of clinical, genetic and serological markers.
        Autoimmun Rev. 2016; 15: 1013-1030
        • Spinelli FR
        • Barone F
        • Cacciapaglia F
        • Pecani A
        • Piga M.
        Atherosclerosis and autoimmunity.
        Mediators Inflamm. 2018; 2018 (Mar 29)6730421
        • Skeoch S
        • Bruce IN.
        Atherosclerosis in rheumatoid arthritis: is it all about inflammation?.
        Nat Rev Rheumatol. 2015; 11: 390-400
        • Agca R
        • Heslinga SC
        • Rollefstad S
        • et al.
        EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update.
        Ann Rheum Dis. 2017; 76: 17-28
        • Cacciapaglia F
        • Fornaro M
        • Venerito V
        • et al.
        Cardiovascular risk estimation with 5 different algorithms before and after 5 years of bDMARD treatment in rheumatoid arthritis.
        Eur J Clin Invest. 2020; 50: e13343
        • Ridker PM
        • Buring JE
        • Rifai N
        • et al.
        Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score.
        JAMA. 2007; 297: 611-619
        • Conroy RM
        • Pyörälä K
        • Fitzgerald AP
        • et al.
        Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project.
        Eur Heart J. 2003; 24: 987-1003
        • Donfrancesco C
        • Palmieri L
        • Cooney MT
        • et al.
        Italian cardiovascular mortality charts of the CUORE project: are they comparable with the SCORE charts?.
        Eur J Cardiovasc Prev Rehabil. 2010; 17: 403-409
        • Hippisley-Cox J
        • Coupland C
        • Brindle P.
        Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study.
        BMJ. 2017; 357: j2099
        • Solomon DH
        • Greenberg J
        • Curtis JR
        • et al.
        Derivation and internal validation of an expanded cardiovascular risk prediction score for rheumatoid arthritis: a consortium of rheumatology researchers of North America registry study.
        Arthritis Rheumatol. 2015; 67: 1995-2003
        • Colaco K
        • Ocampo V
        • Ayala AP
        • et al.
        Predictive utility of cardiovascular risk prediction algorithms in inflammatory rheumatic diseases: a systematic review.
        J Rheumatol. 2020; 47: 928-938
        • Corrales A
        • González-Juanatey C
        • Peiró ME
        • et al.
        Carotid ultrasound is useful for the cardiovascular risk stratification of patients with rheumatoid arthritis: results of a population-based study.
        Ann Rheum Dis. 2014; 73: 722-727
        • Corrales A
        • Vegas-Revenga N
        • Atienza-Mateo B
        • et al.
        Combined use of QRISK3 and SCORE as predictors of carotid plaques in patients with rheumatoid arthritis.
        Rheumatology. 2021; 60: 2801-2807
        • Cacciapaglia F
        • Erre G
        • Sakellariou G
        • et al.
        Cardiovascular risk evaluation in systemic lupus erythematosus and rheumatoid arthritis: preliminary results from the “Cardiovascular Obesity and Rheumatic DISease (CORDIS)” Study Group of the Italian Society of Rheumatology.
        Arthritis Rheumatol. 2019; 71 ([abstract]) (suppl): 2136
        • Aletaha D
        • Neogi T
        • Silman AJ
        • et al.
        Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.
        Arthritis Rheum. 2010; 62 (2010): 2569-2581
        • Reiner Z
        • Catapano AL
        • De Backer G
        • et al.
        ESC Committee for Practice Guidelines (CPG) 2008-2010 and 2010-2012 Committees. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS).
        Eur Heart J. 2011; 32: 1769-1818
        • Palmieri L
        • Donfrancesco C
        • Giampaoli S
        • et al.
        Favorable cardiovascular risk profile and 10-year coronary heart disease incidence in women and men: results from the Progetto CUORE.
        Eur J Cardiov Prev. 2006; 13: 562-570
        • de Campos GC
        • Mundi R
        • Whittington C
        • et al.
        Osteoarthritis, mobility-related comorbidities and mortality: an overview of meta-analyses.
        Ther Adv Musculoskel Dis. 2020; 12: 1-11
        • Cosentino F
        • Grant PJ
        • Aboyans V
        • et al.
        ESC Scientific Document Group, 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD).
        Eur Heart J. 2020; 41: 255-323
        • Corrales A
        • Parra JA
        • González-Juanatey C
        • et al.
        Cardiovascular risk stratification in rheumatic diseases: carotid ultrasound is more sensitive than Coronary Artery Calcification Score to detect subclinical atherosclerosis in patients with rheumatoid arthritis.
        Ann Rheum Dis. 2013; 72: 1764-1770
        • Ferraz-Amaro I
        • Corrales A
        • Quevedo-Abeledo JC
        • et al.
        Disease activity influences the reclassification of rheumatoid arthritis into very high cardiovascular risk.
        Arthritis Res Ther. 2021; 23: 162
        • Crowson CS
        • Rollefstad S
        • Kitas GD
        • et al.
        A Trans-Atlantic Cardiovascular Risk Consortium for Rheumatoid Arthritis (ATACC-RA). Challenges of developing a cardiovascular risk calculator for patients with rheumatoid arthritis.
        PLoS One. 2017; 12e0174656
        • Arts EE
        • Popa CD
        • Den Broeder AA
        • et al.
        Performance of four current risk algorithms in predicting cardiovascular events in patients with early rheumatoid arthritis.
        Ann Rheum Dis. 2015; 74: 668-674
        • Arts EE
        • Popa CD
        • Den Broeder AA
        • et al.
        Prediction of cardiovascular risk in rheumatoid arthritis: performance of original and adapted SCORE algorithms.
        Ann Rheum Dis. 2016; 75: 674-680
        • Corrales A
        • Vegas-Revenga N
        • Rueda-Gotor J
        • et al.
        Carotid plaques as predictors of cardiovascular events in patients with Rheumatoid Arthritis. Results from a 5-year-prospective follow-up study.
        Semin Arthritis Rheum. 2020; 50: 1333-1338
        • Navarini L
        • Margiotta DE
        • Caso F
        • et al.
        Performances of five risk algorithms in predicting cardiovascular events in patients with Psoriatic Arthritis: an Italian bicentric study.
        PLoS One. 2018; 13e0205506
        • Costello RE
        • Marsden A
        • Movahedi M
        • et al.
        The effect of glucocorticoid therapy on mortality in patients with rheumatoid arthritis and concomitant type II diabetes: a retrospective cohort study.
        BMC Rheumatol. 2020; 4: 4
        • Dalbeni A
        • Giollo A
        • Bevilacqua M
        • et al.
        Traditional cardiovascular risk factors and residual disease activity are associated with atherosclerosis progression in rheumatoid arthritis patients.
        Hypertens Res. 2020; 43: 922-928
        • Jin Y
        • Chen SK
        • Liu J
        • et al.
        Risk of incident type 2 diabetes mellitus among patients with rheumatoid arthritis: A population-based cohort study.
        Arthritis Care Res. 2020; 72: 1248-1256
        • Bartoloni E
        • Alunno A
        • Valentini V
        • et al.
        Role of Inflammatory Diseases in Hypertension.
        High Blood Press Cardiovasc Prev. 2017; 24: 353-361
        • Bartoloni E
        • Alunno A
        • Gerli R.
        Hypertension as a cardiovascular risk factor in autoimmune rheumatic diseases.
        Nat Rev Cardiol. 2018; 15: 33-44
        • Cacciapaglia F
        • Perniola S
        • Venerito V
        • et al.
        The impact of biologic drugs on high-density lipoprotein cholesterol efflux capacity in rheumatoid arthritis patients.
        J Clin Rheumatol. 2020; https://doi.org/10.1097/RHU.0000000000001657
        • Fornaro M
        • Cacciapaglia F
        • Venerito V
        • et al.
        Influence of changes in cholesterol levels and disease activity on the 10 years cardiovascular risk estimated with different algorithms in rheumatoid arthritis patients.
        Ann Rheum Dis. 2020; 79: e104
        • Sugiyama D
        • Nishimura K
        • Tamaki K
        • et al.
        Impact of smoking as a risk factor for developing rheumatoid arthritis: a meta-analysis of observational studies.
        Ann Rheum Dis. 2010; 69: 70-81
        • Baghdadi LR
        • Woodman RJ
        • Shanahan EM
        • et al.
        The impact of traditional cardiovascular risk factors on cardiovascular outcomes in patients with rheumatoid arthritis: a systematic review and meta-analysis.
        PLoS One. 2015; 10e0117952
        • Mong N
        • Tarjanyi Z
        • Tothfalusi L
        • et al.
        Largely accelerated arterial aging in rheumatoid arthritis is associated with inflammatory activity and smoking in the early stage of the disease.
        Front Pharmacol. 2020; 11523962
        • Roelsgaard IK
        • Ikdahl E
        • Rollefstad S
        • et al.
        Smoking cessation is associated with lower disease activity and predicts cardiovascular risk reduction in rheumatoid arthritis patients.
        Rheumatology. 2020; 59: 1997-2004