Elena Myasoedova, MD: Cardiovascular Disease in Rheumatoid Arthritis Patients

With rheumatoid arthritis patients predisposed to a slew of comorbidities, including cardiovascular disease, clinicians have been working for decades to minimize the impact of these concomitant conditions.

Results of a study presented at the Clinical Congress of Rheumatology (CCR) West 2019 annual meeting in San Diego, CA, are suggesting their efforts may be paying dividends in the form of declining cardiovascular disease rates among patients.

The study, which was carried out by investigators at the Mayo Clinic in Rochester, MN, examined rates of incident cardiovascular disease in patients with rheumatoid arthritis over the course of 3 decades. In models adjusted for age and sex, investigators compared rates during the 1980s, 1990s, and 2000s—with follow-up continuing until 2016.

Upon analyses, investigators found rates of myocardial infarction, stroke, congenital heart disease death, and overall cardiovascular events had declined markedly from 1980 to 2009—the final year of the study. To learn more about the impact of declining rates and a more in-depth look at the study, MD Magazine® sat down with lead author Elena Myasoedova, MD, rheumatologist at the Mayo Clinic.

MD Mag: Can you describe the findings of your study into incident cardiovascular disease in patients with rheumatoid arthritis?

Myasoedova: Earlier studies have shown a 2-fold increased risk of cardiovascular disease in patients with rheumatoid arthritis compared to the general population. Recent studies from United States, Canada, and from Europe have shown that cardiovascular mortality in patients with rheumatoid arthritis is improving in the 2000s as compared to the previous decades. With this study we aimed to look at cardiovascular disease incidence across 3 decades—1980s, 1990s and 2000—and comparing it with non-RA population, general population of Olmstead County, Minnesota.

So, we did a retrospective cohort study enumerating patients from Olmsted County Minnesota who have rheumatoid arthritis and ascertaining cardiovascular disease in this cohort and comparing this cohort to non-RA population age- and sex-matched comparators. We looked at cardiovascular disease events such as myocardial infarction and stroke as well as death from coronary heart disease. The decades we analyzed were 1980s 1990s and 2000's, this would be when RA criteria for 1987 were met for a particular RA subject.

So, this is an incident cohort of RA patients diagnosed during the 1980s, 1990s, and 2000's and similarly matched non-RA comparators on age, sex, and index state. We followed up our population through 2016, through December of 2016.

What we found is that cumulative incidence of cardiovascular disease, any event, was much lower in patients with rheumatoid arthritis diagnosed in 2000's as compared to 1980s and 1990s. The gap in the excess risk of cardiovascular disease in patients with rheumatoid arthritis as compared to general population appears to also be diminishing in this most recent cohort in 2000's. We observed almost half risk of cardiovascular disease in patients with rheumatoid arthritis diagnosed in 2000s as compared to 1980s and then no excess risk as compared to non-RA population in this same 2000s decade.

So, overall the impression is that cardiovascular morbidity is improving the incidence of cardiovascular disease is declining in patients with rheumatoid arthritis over time and as compared to non-RA population.

This is a very encouraging trend and certainly several factors can be contributing. From this observational study, we wouldn't be able to say what exactly was driving these trends, but improvement in treatment of rheumatoid arthritis with a treat-to-target approach and use of biologics may have an influenced these trends as well as improvement in optimization management of preventative cardiovascular health and management of cardiovascular disease risk with increased awareness of that over the previous decade.