Excess Cardiovascular Risk Linked to Rheumatoid Arthritis Less Prevalent Since 2000

New treatment strategies for rheumatoid arthritis led to a reduction in congestive heart failure and cardiovascular mortality after the year 2000.

The excess risk of cardiovascular events in patients with rheumatoid arthritis (RA) has been on the decline since the 21st century.

Compared with the general population, patients with RA have an increased risk of cardiovascular events, such as congestive heart failure, cardiovascular mortality, myocardial infarction, and stroke.

In a new meta-analysis presented at the Annual European Congress of Rheumatology 2017, investigators found that although there is an increased risk among this patient population, the excess risk appears to be less prevalent compared with the year 2000.

“This reduction in cardiovascular risk may have 2 explanations,” said Elisabeth Filhol, rheumatologist in training at Nîmes University Hospital in France. “It may simply be due to better management of cardiovascular risk in patients with RA.”

For the study, the investigators conducted a detailed literature search—–including PubMed and Cochrane Library––up until March 2016 to assess the excess risk of cardiovascular events in patients with RA.

Twenty-eight observational studies that provided data on the occurrence of cardiovascular events in patients with RA and in a control group were eligible.

For each cardiovascular event and each period—–before and after the 2000s––the investigators conducted a meta-analysis of the relative risk regarding patients with RA in relation to the control group.

In studies published before 2000, the investigators observed a highly significant increase in the risk of all 4 cardiovascular events in patients with RA compared with the controls.

Studies published after 2000 showed that the increased cardiovascular risk was not related to congestive heart failure and cardiovascular mortality. The excess risk of myocardial infarction was reduced compared with the period before 2000, and the excess risk of stroke remained stable.

However, based on the knowledge that systemic inflammation is the “cornerstone” of RA and atherosclerosis, senior investigator Cécile Gaujoux-Viala speculates that “it may also be related to better control of chronic systemic inflammation as the result of new therapeutic strategies.

“Over the past 15 years, new treatment strategies such as tight control, treat to target, methotrexate optimization, and the use of biologic [disease-modifying anti-rheumatic drugs] DMARDs has allowed a better control of systemic inflammation in patients with RA,” Gaujoux-Viala said.