BOSTON, Massachusetts—More than half of 50 to 59 year olds newly diagnosed with rheumatoid arthritis (RA) and those aged >e;60 years have a >e;10% risk of developing heart disease within the next 10 years. They can substantially benefit from cardiovascular (CV) risk reduction strategies tailored to their specific risk profiles, report researchers at the annual meeting of the American College of Rheumatology in Boston. The findings by researchers with the Mayo Clinic in Rochester, Minnesota, should urge rheumatologists to aggressively identify and treat CV risk factors early on in the RA disease process, the experts said.

"There is a window of opportunity early in the disease course to assess cardiovascular disease risk," said lead researcher Hilal Maradit Kremers, MD, Mayo Clinic epidemiologist. The findings "highlight the importance of assessing well-known traditional cardiovascular risk factors in these patients in addition to assessing arthritis disease characteristics."
The new study estimated the age-specific, 10-year absolute risk of CV disease in 553 newly diagnosed RA patients who were free of CV disease at RA onset and compared them with 574 people without RA. The patients had an average age of 57, and 73% were women. Study subjects were classified into five risk categories based on their 10-year absolute risk of combined CV endpoint. Specifically, CV risk was defined as a percentage of risk over the next 10 years: low-risk was defined as a <6% CV risk, low-to-moderate risk was defined as 6% to 10% risk, intermediate risk as a 10% to 20% risk, high risk as a 20% to 50% risk, and very high risk a >50% risk.

10-year absolute CV risk higher in RA

"The 10-year absolute risk is much higher in RA patients, compared with matched, nondisease individuals," Dr. Kremers said.

In each age group, the cardiovascular risk, including risk of myocardial infarction, heart failure, and cardiovascular death, was similar to the risk of people 5 to 10 years older, the study found.

The proportion of newly diagnosed 50- to 59-year-old RA subjects with intermediate or higher 10-year risk of CV events was 85% compared with 27% among nonRA subjects. Moreover, the proportion of 60- to 69-year-old RA subjects with intermediate or higher risk of CV events was 100% compared with 79% among nonRA subjects. Similarly, the proportion of 60- to 69-year-old RA subjects with a high/very high risk of CV events was 85% compared with only 40% among nonRA subjects.

Rheumatologists should take heed

Daniel  H. Solomon, MD, MPH, an associate physician at Brigham and Women's Hospital in Boston, Massachusetts, said the study findings "help us understand how we should think about these patients in the office. Their hearts are like a person who is 5 to 10 years older, and it tells us that we need to spend careful attention quantifying and managing other [CV] variables and perhaps do imaging."

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