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

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Arthritis Research & Therapy 2008, 10:R30doi:10.1186/ar2383

Published: 6 March 2008

Research article

Cardiovascular disease in patients with rheumatoid arthritis: results

from the QUEST-RA study

Naranjo , Tuulikki Sokka , A Descalzo ,

Calvo-Alén , Kim Hørslev-sen , Reijo K Luukkainen , Bernard Combe

, Gerd R Burmester , Joe Devlin , Gianfranco Ferraccioli , Alessia

Morelli , Hoekstra , Majdan , Stefan Sadkiewicz ,

Belmonte , Ann-Carin Holmqvist , Ernest Choy , Recep Tunc , Aleksander

Dimic , Bergman , Toloza and Theodore Pincus for the

QUEST-RA Group

Abstract (provisional)

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.

http://arthritis-research.com/content/10/2/R30/abstract

Full text: http://arthritis-research.com/content/pdf/ar2383.pdf

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