Objective:

To investigate the association between rheumatoid arthritis (RA) disease activity and the risk of major adverse cardiovascular events, considering patients' serostatus.

Approach:

• Study Design: Data from 3,952 patients with prevalent RA and no established cardiovascular disease were analyzed, following them from enrollment until a first major adverse cardiovascular event, death, migration, or censoring.
• Outcome Measures: The primary outcome included nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death, with disease activity measured using the Disease Activity Score in 28 joints with C-reactive protein (DAS28-CRP).
• Statistical Analysis: Adjusted analyses were performed to assess the relationship between baseline DAS28-CRP and the hazard of cardiovascular events, accounting for demographic and cardiovascular risk factors.

Key Findings:

• Each 1-unit increase in baseline DAS28-CRP was associated with an 18% higher hazard of a first major adverse cardiovascular event.
• 184 patients experienced a first major adverse cardiovascular event during 22,981 patient-years of follow-up.
• Higher DAS28-CRP scores were linked to cardiovascular events in patients negative for both rheumatoid factor (RF) and anticitrullinated protein antibody (ACPA), and those positive for both, while associations in the single-positive groups did not reach statistical significance.

Interpretation:

Combined serostatus may influence the relationship between inflammatory activity and cardiovascular outcomes in RA patients.

Limitations:

• Disease activity and cardiovascular risk factors were assessed only at enrollment, limiting the ability to account for changes over time.
• The study lacked detailed information on RF and ACPA titers, isotypes, and specificities.
• Cardiovascular events were not centrally adjudicated, and recruitment bias may have been introduced.

Conclusion:

Serostatus may modify the association between RA disease activity and cardiovascular risk.

Sources:

• RMD Open