RESEARCH - Progression of cardiovascular co-morbidity in early RA

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Presentation Time: 11/9/2007 8:00:00 AM

Title: Progression of Cardiovascular Co-Morbidity in Early RA

Category: 17. RA: clinical aspects

Author(s): Lena Innala1, Sodergren1, Lotta Ljung1, Staffan

Magnusson2, Torgny Smedby3, Lisbet Söderlund4, Solbritt

Rantapää-Dahlqvist1, Solveig Wållberg-Jonsson1. 1Department of

Rheumatology, Ume�, Sweden; 2Department of Rheumatology, Sundsvall,

Sweden; 3Department of Rheumatology, Östersund, Sweden; 4Department

of Rheumatology, Sunderbyn, Luleå, Sweden

Mortality is increased in patients with Rheumatoid arthritis (RA) (1).

Cardiovascular disease (CVD) is the most common underlying cause, but

the reasons for this are not fully understood.

Purpose: To delineate the progress of CVD and related risk factors,

traditional and disease related, in a large cohort of patients with

RA, prospectively from disease onset and followed-up for 5 years.

Methods: All patients from the 4 most northern counties of Sweden

diagnosed with early RA (<12 months) are consecutively included in a

large survey on the progress of the disease and co-morbidity, in

particular CV events (CVE). All patients are followed clinically on

regular basis, blood samples are collected and a survey of

co-morbidity is made at inclusion (T0) and after 5 years (T5). Data

from the patient records are thoroughly extracted at T0 and T5. The

following information is registered: All co-morbidity including CVE

(myocardial infarction/CABG, stroke/TIA,DVT), traditional CV risk

factors, lipid levels, corticosteroid and antirheumatic treatment.

Predictors for co-morbidity are evaluated.

Results: In all, 632 patients with recent onset RA have been included

(443f, 193m, mean age 53.8±14.5) mean 6.4 months after the first

signs of disease. Of these, 257 have reached 5 years. Patients at T0

had 24.4% treatment for hypertension, 4.5% diabetes, 28.2% were

smokers (66.2% ever smokers), 6.6% had a previous CVD, 48.1% used

NSAID, 11.4% coxxibs, and 8.7% statins. Mean BMI was (f/m) 26.5/26.7,

cholesterol (f/m) 5.7/ 5.6. At T0 mean ESR was 30.9, CRP 21.8, DAS28

7.0, HAQ 0.99, TJC 7.0, SJC 8.5, VAS pain 43.9, VAS global 44.9. 74.2%

were RF pos, 68.1% anti-CCP pos and 56.4% carried HLA-SE (0401/0404).

After 5 years (at T5) 21 patients had experienced a new CVE. The

number of patients with treatment for hypertension had increased

significantly (34.5 vs 24.4, p<0.05). In simple logistic regression

models, age at onset of RA (p<0.05) and hypertension (p<0.01)

predicted a new CVE, whilst months of treatment with DMARDs and

treatment with NSAIDs (p<0.05 for both) reduced the risk for CVE.

Presence of anti-CCP antibodies, or RF, DAS28 or HAQ at baseline had

no impact. HLA-SE and lower levels of HDL-cholesterol predicted CVE

with borderline significance (p=0.095 and 0.082 respectively).

Conclusions: In patients with early RA, followed up for 5 years,

hypertension had increased significantly over time and predicted,

together with age, a new CVE. Antirheumatic treatment reduced the

risk.

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