Rheumatoid arthritis as cardiovascular risk factor: an update

Rheumatoid arthritis (RA) patients have a 1.5 – 2.5 higher chance to develop cardiovascular diseases (CVD), which in turn represent the most important cause of mortality and the most frequent comorbidity in these patients. Chronic inflammation crucially contributes to that, either as an independent risk factor or as a modulator of traditional cardiovascular (CV) risk factors, such as dyslipidemia and hypertension. The cardiovascular risk management (CVRM) is therefore essential in these patients. The implementation of it in the daily practice is quite challenging and requires a good networking between different specialists (rheumatologist, cardiologist, internist) and the general practitioners (GPs), and may get various forms of organization depending on region and locations.

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Incidence of venous and arterial thromboembolic events reported in the tofacitinib rheumatoid arthritis, psoriasis and psoriatic arthritis development programmes and from real-world data

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2019-216761 ◽

2020 ◽

Vol 79 (11) ◽

pp. 1400-1413 ◽

Cited By ~ 2

Author(s):

Philip Mease ◽

Christina Charles-Schoeman ◽

Stanley Cohen ◽

Lara Fallon ◽

John Woolcott ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Risk Factor ◽

Cardiovascular Risk ◽

Psoriatic Arthritis ◽

Cardiovascular Risk Factors ◽

Cardiovascular Risk Factor ◽

Ad Hoc ◽

Thromboembolic Events ◽

The Us

ObjectivesTofacitinib is a Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ulcerative colitis, and has been investigated in psoriasis (PsO). Routine pharmacovigilance of an ongoing, open-label, blinded-endpoint, tofacitinib RA trial (Study A3921133; NCT02092467) in patients aged ≥50 years and with ≥1 cardiovascular risk factor identified a higher frequency of pulmonary embolism (PE) and all-cause mortality for patients receiving tofacitinib 10 mg twice daily versus those receiving tumour necrosis factor inhibitors and resulted in identification of a safety signal for tofacitinib. Here, we report the incidence of deep vein thrombosis (DVT), PE, venous thromboembolism (VTE; DVT or PE) and arterial thromboembolism (ATE) from the tofacitinib RA (excluding Study A3921133), PsA and PsO development programmes and observational studies. Data from an ad hoc safety analysis of Study A3921133 are reported separately within.MethodsThis post-hoc analysis used data from separate tofacitinib RA, PsO and PsA programmes. Incidence rates (IRs; patients with events per 100 patient-years’ exposure) were calculated for DVT, PE, VTE and ATE, including for populations stratified by defined baseline cardiovascular or VTE risk factors. Observational data from the US Corrona registries (including cardiovascular risk factor stratification), IBM MarketScan research database and the US FDA Adverse Event Reporting System (FAERS) database were analysed.Results12 410 tofacitinib-treated patients from the development programmes (RA: n=7964; PsO: n=3663; PsA: n=783) were included. IRs (95% CI) of thromboembolic events among the all tofacitinib cohorts’ average tofacitinib 5 mg and 10 mg twice daily treated patients for RA, respectively, were: DVT (0.17 (0.09–0.27) and 0.15 (0.09–0.22)); PE (0.12 (0.06–0.22) and 0.13 (0.08–0.21)); ATE (0.32 (0.22–0.46) and 0.38 (0.28–0.49)). Among PsO patients, IRs were: DVT (0.06 (0.00–0.36) and 0.06 (0.02–0.15)); PE (0.13 (0.02–0.47) and 0.09 (0.04–0.19)); ATE (0.52 (0.22–1.02) and 0.22 (0.13–0.35)). Among PsA patients, IRs were: DVT (0.00 (0.00–0.28) and 0.13 (0.00–0.70)); PE (0.08 (0.00–0.43) and 0.00 (0.00–0.46)); ATE (0.31 (0.08–0.79) and 0.38 (0.08–1.11)). IRs were similar between tofacitinib doses and generally higher in patients with baseline cardiovascular or VTE risk factors. IRs from the overall Corrona populations and in Corrona RA patients (including tofacitinib-naïve/biologic disease-modifying antirheumatic drug-treated and tofacitinib-treated) with baseline cardiovascular risk factors were similar to IRs observed among the corresponding patients in the tofacitinib development programme. No signals of disproportionate reporting of DVT, PE or ATE with tofacitinib were identified in the FAERS database.ConclusionsDVT, PE and ATE IRs in the tofacitinib RA, PsO and PsA programmes were similar across tofacitinib doses, and generally consistent with observational data and published IRs of other treatments. As expected, IRs of thromboembolic events were elevated in patients with versus without baseline cardiovascular or VTE risk factors, and were broadly consistent with those observed in the Study A3921133 ad hoc safety analysis data, although the IR (95% CI) for PE was greater in patients treated with tofacitinib 10 mg twice daily in Study A3921133 (0.54 (0.32–0.87)), versus patients with baseline cardiovascular risk factors treated with tofacitinib 10 mg twice daily in the RA programme (0.24 (0.13–0.41)).

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Cardiovascular risk factors in chronic renal failure patient at Soavinandriana Hospital Antananarivo

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20202906 ◽

2020 ◽

Vol 8 (7) ◽

pp. 2622

Author(s):

Lucas Z. Randimbinirina ◽

Fanomezantsoa H. Randrianandrianina ◽

Tsirimalala Rajaobelison ◽

Jean Claude A. Rakotoarisoa ◽

Agnes M. L. Ravalisoa

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Renal Failure ◽

Risk Factor ◽

Cardiovascular Risk ◽

Chronic Renal Failure ◽

Cardiovascular Diseases ◽

Cardiovascular Risk Factors ◽

Cardiovascular Risk Factor ◽

High Cardiovascular Risk

Background: Cardiovascular disease (CVD) is the primary cause of morbidity and premature mortality in chronic kidney disease (CKD). The aim of this study was to assess the frequency of cardiovascular disease and cardiovascular risk in haemodialysis population for chronic kidney disease.Methods: This was a retrospective and descriptive study for a period of 4 years from January 2016 to December 2019, performed at hemodialysis unit in Soavinandriana Hospital Center Antananarivo, including all patients, following regular hemodialysis for chronic renal failure. Demographic data, cardiovascular disease, cardiovascular risk factors, aetiology of nephropathy, haemoglobin <11 g/dl, phosphocalcic metabolism disorders and uricemia were analyzed.Results: Seventy-six patients were recorded, including 46 males (60.52%) and were women (39.47%). The average age was 59.98 years old. The risk factors of cardiovascular disease were smoking (22.36%), diabetes mellitus (46.05%), high blood pressure (71.05%), dyslipidemia (47.36%) and obesity (11.84%). Fifty-eight patients (76.31%) had a high cardiovascular risk factor. Seventy patients (22.36%) had had a history of cardiovascular diseases. Fifty-nine patients had a haemoglobin concentration under 11 g/dl (77.63%). There were 23 cases of hypocalcemia (30.26%), 22 cases of hyperphosphatemia (28.94%) and 37 cases of hyperuricemia (48.68%).Conclusions: There was a high cardiovascular risk factor in this study population. Early detection of cardiovascular diseases should be done in patients who have a high-risk factor of cardiovascular disease to decrease the mortality rate in chronic kidney diseases population. The appropriate management of modifiable risk factors is important to improve the survival of this study patients.

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Rheumatoid Arthritis Is an Independent Risk Factor for an Increased Augmentation Index Regardless of the Coexistence of Traditional Cardiovascular Risk Factors

Seminars in Arthritis and Rheumatism ◽

10.1016/j.semarthrit.2012.02.003 ◽

2012 ◽

Vol 42 (1) ◽

pp. 17-22 ◽

Cited By ~ 15

Author(s):

Herwig Pieringer ◽

Tobias Brummaier ◽

Michael Schmid ◽

Max Pichler ◽

Avida Hayat-Khayyati ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Risk Factor ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Independent Risk Factor ◽

Augmentation Index

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SAT0077 CARDIOVASCULAR RISK ASSESSMENT WITH CAROTID ULTRASONOGRAPHY IN ADDITION TO THE TRADITIONAL CARDIOVASCULAR RISK FACTORS IN RHEUMATOID ARTHRITIS PATIENTS: A CASE CONTROL STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6420 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 973-973

Author(s):

R. Gonzalez Mazario ◽

J. J. Fragio-Gil ◽

P. Martinez Calabuig ◽

E. Grau García ◽

M. De la Rubia Navarro ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Risk Factor ◽

Cardiovascular Risk ◽

Disease Duration ◽

Case Control Study ◽

Case Control ◽

Healthy Controls ◽

Carotid Ultrasonography ◽

Control Study

Background:Cardiovascular disease (CV) is the most frequent cause of death in rheumatoid arthritis (RA) patients. It is well known that RA acts as an independent cardiovascular risk factor.Objectives:To assess the CV risk in RA patients using carotid ultrasonography (US) additionally to the traditional CV risk factors.Methods:A prospective transversal case control study was performed, including adult RA patients who fulfilled ACR/EULAR 2010 criteria and healthy controls matched according to CV risk factors. Population over 75 years old, patients with established CV disease and/or chronic kidney failure (from III stage) were excluded. The US evaluator was blinded to the case/control condition and evaluated the presence of plaques and the intima-media thickness. Statistical analysis was performed with R (3.6.1 version) and included a multivariate variance analysis (MANOVA) and a negative binomial regression adjusted by confounding factors (age, sex and CV risk factors).Results:A total of 200 cases and 111 healthy controls were included in the study. Demographical, clinical and US data are exposed in table 1. Not any difference was detected in terms of CV risk factors between the cases and controls. In both groups a relationship between age, BMI and high blood pressure was detected (p<0.001).Table 1.Table 2.RA basal characteristicsDisease duration (years)16,98 (11,38)Erosions (X-Ray of hands/feet)163 (81,5%)Seropositive (RF/anti-CCP)146 (73%)Extra-articular symptoms44 (22%)Intersticial difusse lung disease10 (5%)Rheumatoid nodules14 (7%)Prednisone use103 (51,5%)Median dose of Prednisone last year (mg)2,34 (2,84)sDMARDsMethotrexate104 (52%)Leflunomide29 (14,5%)Hydroxycloroquine9 (4,5%)bDMARDs89 (44,5%) TNFi41 (20,5%) Abatacept15 (7,5%) IL6i22 (11%) RTX11 (5,5%)JAKi26 (13%) Baricitinib11 (5,5%) Tofacitinib15 (7,5%)DAS 28-ESR3,1 (2,3, 3,9)SDAI7,85 (4,04, 13,41)HAQ0,88 (0,22, 1,5)RF (U/mL)51 (15, 164,25)Anti-CCP (U/mL)173 (22, 340)Patients showed higher intima-media (both right and left) thickness compared to controls (p<0.006). Moreover it was also related to the disease duration and DAS28 score (p<0.001). A higher plaque account was noted in cases(p<0.004) and it was also related to the disease duration (p<0.001).Conclusion:RA implies a higher CV risk. Traditional CV risk factors explains only partially the global risk. These findings support that RA acts as an independent cardiovascular risk factor.Disclosure of Interests:None declared

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An absolute risk-guided approach to cardiovascular risk management within a chest pain clinic: the ARCPAC randomized trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.2916 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J.A Black ◽

J Campbell ◽

J Sharman ◽

M Nelson ◽

S Parker ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cardiovascular Risk ◽

Chest Pain ◽

Smoking Status ◽

Absolute Risk ◽

Pain Clinic ◽

Risk Scores ◽

Cardiovascular Risk Management ◽

Risk Factor Management

Abstract Background The majority of patients attending chest pain clinics are found not to have a cardiac cause of their symptoms, but have a high burden of cardiovascular risk factors that may be opportunistically addressed. Absolute risk calculators are recommended to guide risk factor management, although it is uncertain to what extent these calculations may assist with patient engagement in risk factor modification. Purpose We sought to determine the usefulness of a proactive, absolute risk-based approach, to guide opportunistic cardiovascular risk factor management within a chest pain clinic. Methods This was a prospective, open-label, blinded-endpoint study in 192 enhanced risk (estimated 5-year risk ≥8%, based on Australian Absolute Risk Calculator) patients presenting to a tertiary hospital chest pain clinic. Patients were randomized to best practice usual care, or intervention with development of a proactive cardiovascular risk management strategy framed around a discussion of the individual's absolute risk. Patients found to have a cardiac cause of symptoms were excluded as they constitute a secondary prevention population. Primary outcome was 5-year absolute cardiovascular risk score at minimum 12 months follow up. Secondary outcomes were individual modifiable risk factors (lipid profile, blood pressure, smoking status). Results 192 people entered the study; 100 in the intervention arm and 92 in usual care. There was no statistical difference between the two groups' baseline sociodemographic and clinical variables. The intervention group showed greater reduction in 5-year absolute risk scores (difference −2.77; p<0.001), and more favourable individual risk factors, although only smoking status and LDL cholesterol reached statistical significance (table). Conclusion An absolute risk-guided proactive risk factor management strategy employed opportunistically in a chest pain clinic significantly improves 5-year cardiovascular risk scores. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Tasmanian Community Fund

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