Researchers Predict Cardiovascular Risk for People

Newswise — Patients with rheumatoid arthritis are at an increased risk of developing cardiovascular disease. Researchers at Mayo Clinic have now developed a simple approach to predict the risk of cardiovascular events within ten years of diagnosis of rheumatoid arthritis, according to research presented at the American College of Rheumatology Annual Scientific Meeting in Boston, Mass.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 2.1 million Americans have RA, most of them women.

A major challenge rheumatologists face is detection, treatment and prevention of cardiovascular disease in patients with RA who have no symptoms of heart disease—yet are at increased risk.

Researchers estimated the age-specific 10-year absolute risk of cardiovascular disease in 553 newly diagnosed RA patients free of cardiovascular disease at RA onset and compared them to 574 people without RA. The patients were 57 years old, on average, and 73 percent were women. Study subjects were classified into risk categories, depending on their chance of developing cardiovascular disease in the next ten years.

Using this unique analytic approach, which takes the traditional cardiovascular risk factors into account, researchers found that 85 percent of 60-69 year old newly diagnosed patients have at least a 1 in 5 chance of developing a serious cardiovascular event, such as a heart attack, heart failure or cardiac death, within the next 10 years. "This is approximately double the risk for people of the same age and sex without RA," explained Hilal Maradit Kremers, MD, Mayo Clinic epidemiologist and lead author of the study. "And, this difference in risk is even greater in women"

"These results emphasize the importance of performing a comprehensive cardiovascular risk assessment for all newly diagnosed RA patients," said Sherine Gabriel, MD, Mayo Clinic rheumatologist, epidemiologist and the study's senior author. "In this way, cardiovascular risk reduction strategies can be specifically tailored for patients with RA."

The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases. For more information on the ACR's annual meeting, see http://www.rheumatology.org/annual.

Editor's Notes: Dr. Kremers will present this research during the ACR Annual Scientific Meeting at the Boston Convention and Exhibition Center from 11:00 am " 12:30 pm ET on Sunday, November 11, 2007, in Room 253. Dr. Kremers will be available for media questions and briefing at 8:30 am ET on Thursday, November 8 in the on-site press conference room, Room 251. Presentation Number: 2185

High 10-year Cardiovascular Risk in Newly Diagnosed Rheumatoid Arthritis (RA) Patients

Hilal Maradit Kremers, Cynthia S. Crowson, Terry M. Therneau, Veronique L. Roger, Sherine E. Gabriel. Mayo Clinic, Rochester, MN

Purpose: RA patients are at increased risk of cardiovascular (CV) disease soon after diagnosis. A major challenge is detection, treatment and prevention of CV disease in patients who have no symptoms of heart disease and yet are at increased risk. The purpose of our study was to estimate the age-specific 10-year absolute risk of CV events in newly diagnosed RA subjects.

Methods: The study included a population-based incidence cohort of RA subjects (ACR criteria) and age and sex-matched non-RA subjects ascertained between 1955-1995. Subjects with a history of CV disease at RA incidence were excluded. All subjects were followed up until death, migration or 1-1-2007. Data were collected on CV risk factors and CV events using established epidemiological criteria. Combined CV endpoint included silent or non-fatal myocardial infarctions, coronary revascularization procedures, heart failure and CV deaths. Cox regression models were used to estimate the 10-year risk of combined CV endpoint, adjusting for CV risk factors. Subjects were classified into 5 risk categories based on their 10-year absolute risk of combined CV endpoint: low-risk (<6% CV risk over the next 10 years), low- moderate (6%-10% risk), intermediate (10%-20 % risk), high (20-50% risk) and very high risk (>50%).

Results: A total of 553 RA and 574 non-RA subjects with similar age and sex (mean age of 57 years, 73% women) had a median follow-up of 12.0 and 14.7 years, respectively. The proportion of newly diagnosed 50-59 year old RA subjects with intermediate or higher 10-year risk of CV events was 85% as compared to 27% among non-RA subjects (see Figure). The proportion of 60-69 year old RA subjects with intermediate or higher risk of CV events was 100% as compared to 79% among non-RA subjects. Similarly, the proportion of 60-69 year old RA subjects with a high or very high risk of CV events was 85% as compared to only 40% among non-RA subjects. The absolute CV risk in RA subjects was similar to that of non-RA subjects 5-10 years older, with an even greater difference in women.

Conclusion: Our absolute risk assessment analyses show that more than half of the 50-59 year old newly diagnosed RA subjects and all of those >60 years of age have 10% or greater risk of CV disease within the next 10 years and can substantially benefit from CV risk reduction strategies tailored to their specific risk profiles. Consideration of absolute CV risk categories in RA can facilitate clinical decisions concerning CV disease prevention in RA subjects. Further research is needed to develop RA specific CV risk scores as well as the potential absolute risk reductions with various preventive strategies.

Disclosure Block: H. Maradit Kremers, None; C.S. Crowson, None; T.M. Therneau, None; V.L. Roger, None; S.E. Gabriel, None.