AB0117\u2005CARDIOVASCULAR MORBIMORTALITY IN RHEUMATOID ARTHRITIS: A 5 YEAR FOLLOW-UP STUDY

Abstract

Rheumatoid arthritis (RA) is characterized by elevated cardiovascular morbimortality. RA patients have a higher risk to develop cardiovascular comorbidities when compared to the general population, being the main cause of mortality in these patients. Cardiovascular risk factors (CVRF) are well known, but their management is not optimal, increasing the risk of having a major heart disease (1).To assess the prevalence of the main causes of morbimortality and development of CVRF in RA patients during a five-year follow-up period.A longitudinal and prospective study of a RA cohort from 2014-2019 was performed in a Cardio Rheumatology outpatient clinic at the University Hospital “Dr. Jose E. Gonzalez”, UANL. Patients aged 40-75 years with RA according to ACR/EULAR 2010 criteria were recruited. At both visits, demographic, clinical variables, and lipid profile were recorded. Outcomes included the development of cardiovascular comorbidity: hypertension, diabetes mellitus (DM), dyslipidemia, myocardial infarction, stroke. Survival probabilities and outcomes cumulative frequencies were calculated according to the Kaplan-Meier lifetime analysis method. Descriptive analysis: frequencies (%), mean (SD), or median (q25-q75). Comparisons with McNemar and Student’s t test.A follow-up was done in a total of 92 patients. During the follow-up, 9 patients (9.8%) died, 3 died of cardiovascular death (one myocardial infarction and two strokes). The mean age of death was 67.2 ± 10.5 years. CVRF at baseline (T0) and after five years (T5) are shown in table 1. Of the remain 83 patients, 11 patients (13.3%) developed hypertension (p=0.001), 8 (9.6%) patients developed DM (p=0.031). The number of patients with dyslipidemia decreased significantly to 14 (16.9%) (p=0.031), 4 (4.8%) developed a stroke. A survival probability of 95.7% was found at the five-year follow-up from the time of entry into the cardio rheumatology clinic (Figure 1 next page) and a 30.1% probability of developing cardiovascular comorbidity.This long-term study provides updated information on RA morbimortality characteristics in our population. Patients with RA still develop significant cardiovascular comorbidities despite current treatment. In this cohort, hypertension and DM became more prevalent, and a 96% cardiovascular death-free survival was found. Is imperative to increase the effort in determining optimal markers and therapeutic measures to continue with the prevention of these comorbidities.[1]Semb AG, Ikdahl E, Wibetoe G, et al. Atherosclerotic cardiovascular disease prevention in rheumatoid arthritis. Nat Rev Rheumatol 2020;16(7):361-79. doi: 10.1038/s41584-020-0428-y.Table 1.Demographic and clinical characteristics at the time of inclusion and at 5 years.T0(n=83)T5(n=83)pAge years, mean ± SD56.0 ± 8.9-Female, n (%)75 (90.4)-Disease duration years median (q25-q75)10.4 (4.4-15.7)-CVRF, n (%)\u2003Hypertension27 (32.5)38 (45.8)0.001\u2003Dyslipidemia25 (30.1)16 (19.3)0.041\u2003DM6 (7.2)14 (16.9)0.008\u2003Active smoking8 (9.6)6 (7.2)NS\u2003Overweight/Obesity67 (81.7)63 (81.9)NS\u2003Stroke04 (4.8)-Clinical characteristics\u2003BMI kg/m2, mean ± SD28.1 ± 4.128.5± 4.3NS\u2003SBP mmHg, mean ± SD123.7 ± 18.4126.9± 16.8NS\u2003Total cholesterol mg/dl, mean ± SD180.8 ± 29.0173.9± 34.2NS\u2003Triglycerides mg/dl, mean ± SD136.1 ± 56.1146.1± 64.2NS\u2003HDL-C mg/dl, mean ± SD55.2 ± 16.355.1± 15.9NS\u2003Statins, n (%)9 (10.8)13(15.7)NS\u2003Methotrexate, n (%)71 (85.5)63 (75.9)0.039\u2003Glucocorticoids, n (%)49 (59)40 (48.2)NSNS, non-significant; CVRF, cardiovascular risk factors; DM, diabetes mellitus; BMI, body mass index; SBP, systolic blood pressure; HDL-C, high density lipoprotein cholesterol.None declared