Excess risk of cardiovascular events has decreased in rheumatoid arthritis patients

In rheumatoid arthritis (RA) patients, although the excess risk of cardiovascular events compared with the general population is increased, it has decreased since 2000, according to results of a meta-analysis presented at the annual meeting of the European Congress of Rheumatology 2017.

“This reduction in cardiovascular risk may have two explanations,” said Elisabeth Filhol, a rheumatologist in training, Nîmes University Hospital, France. "It may simply be due to better management of cardiovascular risk in patients with RA.”

“However, knowing that systemic inflammation is the cornerstone of both RA and atherosclerosis, it may also be related to better control of chronic systemic inflammation as the result of new therapeutic strategies,” speculated senior researcher Professor Cécile Gaujoux-Viala, University of Montpellier, head, department of rheumatology, Nîmes University Hospital.

Drs. Filhol and Gaujoux-Viala and colleagues conducted this meta-analysis to assess the excess risk of presenting with a cardiovascular event in RA patients compared with the general population both before and after the 2000s.

A literature search was conducted that included PubMed and the Cochrane Library until March 2016, from which these researchers identified 28 observational studies dealing with the incidence of cardiovascular events, including stroke, myocardial infarction (MI), congestive heart failure (CHF), and cardiovascular mortality (CVM), in patients with RA and a control group.

They then performed a meta-analysis of the relative risk for each cardiovascular event and for each period.

In studies published before 2000, they found a highly significant increase in the risk of all four cardiovascular events in RA patients compared with controls:

• Stroke: RR: 1.12 (95% CI: 1.04, 1.21; P=0.002);
• CHF: RR: 1.25 (95% CI: 1.14, 1.37; P < 0.00001);
• CVM: RR: 1.21 (95% CI: 1.15, 1.26; P < 0.00001); and
• MI: RR: 1.32 (95% CI: 1.24, 1.41; P < 0.00001).

In studies published after 2000, increased cardiovascular risk was not related to CHF and CVM (RR: 1.17; 95% CI: 0.88, 1.56; P=0.27 and RR: 1.07; 95% CI: 0.74, 1.56; P =0.71, respectively).  Compared with the era before 2000, excess risk of MI was reduced (R: 1.18; 95% CI: 1.14, 1.23, P < 0.00001), while the excess risk of stroke was stable (P=0.006).

“Over the past 15 years, new treatment strategies such as tight control, treat to target, methotrexate optimization, and the use of biologic DMARDs has allowed a better control of systemic inflammation in patients with RA,” concluded Professor Gaujoux-Viala.