RESEARCH - Cardiovascular disease in patients with RA: results from QUEST-RA

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Arthritis Res Ther. 2008 Mar 6;10(2):R30

Cardiovascular disease in patients with rheumatoid arthritis: results

from the QUEST-RA study.

Naranjo A, Sokka T, Descalzo MA, Calvo-Alen J, Horslev-sen K,

Luukkainen RK, Combe B, Burmester GR, Devlin J, Ferraccioli G, Morelli

A, Hoekstra M, Majdan M, Sadkiewicz S, Belmonte M, Holmqvist AC, Choy

E, Tunc R, Dimic A, Bergman M, Toloza S, Pincus T.

ABSTRACT: INTRODUCTION: We analyzed the prevalence of cardiovascular

(CV) disease in patients with rheumatoid arthritis (RA) and its

association with traditional CV risk factors, clinical features of RA,

and the use of disease-modifying antirheumatic drugs (DMARDs) in a

multinational cross-sectional cohort of nonselected consecutive

outpatients with RA (The Questionnaires in Standard Monitoring of

Patients with Rheumatoid Arthritis Program, or QUEST-RA) who were

receiving regular clinical care. METHODS: The study involved a

clinical assessment by a rheumatologist and a self-report

questionnaire by patients. The clinical assessment included a review

of clinical features of RA and exposure to DMARDs over the course of

RA. Comorbidities were recorded; CV morbidity included myocardial

infarction, angina, coronary disease, coronary bypass surgery, and

stroke. Traditional risk factors recorded were hypertension,

hyperlipidemia, diabetes mellitus, smoking, physical inactivity, and

body mass index. Unadjusted and adjusted hazard ratios (HRs) (95%

confidence interval [CI]) for CV morbidity were calculated using

proportional hazard regression models. RESULTS: Between January 2005

and October 2006, the QUEST-RA project included 4,363 patients from 48

sites in 15 countries; 78% were female, more than 90% were Caucasian,

and the mean age was 57 years. The prevalence for lifetime CV events

in the entire sample was 3.2% for myocardial infarction, 1.9% for

stroke, and 9.3% for any CV event. The prevalence for CV risk factors

was 32% for hypertension, 14% for hyperlipidemia, 8% for diabetes, 43%

for ever-smoking, 73% for physical inactivity, and 18% for obesity.

Traditional risk factors except obesity and physical inactivity were

significantly associated with CV morbidity. There was an association

between any CV event and age and male gender and between

extra-articular disease and myocardial infarction. Prolonged exposure

to methotrexate (HR 0.85; 95% CI 0.81 to 0.89), leflunomide (HR 0.59;

95% CI 0.43 to 0.79), sulfasalazine (HR 0.92; 95% CI 0.87 to 0.98),

glucocorticoids (HR 0.95; 95% CI 0.92 to 0.98), and biologic agents

(HR 0.42; 95% CI 0.21 to 0.81; P <0.05) was associated with a

reduction of the risk of CV morbidity; analyses were adjusted for

traditional risk factors and countries.

CONCLUSION: In conclusion, prolonged use of treatments such as

methotrexate, sulfasalazine, leflunomide, glucocorticoids, and tumor

necrosis factor-alpha blockers appears to be associated with a reduced

risk of CV disease. In addition to traditional risk factors,

extra-articular disease was associated with the occurrence of

myocardial infarction in patients with RA.

PMID: 18325087

http://www.ncbi.nlm.nih.gov/pubmed/18325087

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