OP0103 5-YEAR CARDIOVASCULAR EVENT RISK IN EARLY RHEUMATOID ARTHRITIS PATIENTS WHO RECEIVED TREAT-TO-TARGET MANAGEMENT: A POPULATION-BASED COHORT STUDY
Authors: T. O. Lam, L. S. Tam
Journal: Annals of the Rheumatic Diseases (2021)

Background: Rheumatoid arthritis (RA) is associated with higher cardiovascular disease (CVD) risk due to the underlying inflammation (1) . It is uncertain if the excess CV risk could be reduced by effective suppression of inflammation using the treat-to-target (T2T) approach in patients with early RA (ERA). Objectives: This study compared the 5-year cardiovascular event (CVE) rate among ERA patients managed by a T2T strategy with a CV risk factor-matched non-RA population. Methods: This was an observational study using the Hong Kong Hospital Authority population-based hospital database known as the Clinical Data Analysis and Reporting System (CDARS) and the Clinical Rheumatology Systematic Treat-to-target in Asia Leadership (CRYSTAL) registry. ERA subjects from the registry with baseline disease duration less than 2 years were recruited between 2012-2016. All patients received a tight control, T2T treatment strategy aiming at remission and had been followed for at least 5 years. Each ERA subject was matched to 3 non-RA controls according to age, gender, smoking status, and the presence of diabetes mellitus (DM), hypertension (HT) and hyperlipidaemia (HL). All subjects on antiplatelet agents, with pre-existing CVD or chronic kidney disease were excluded. All subjects were analysed up to 5 years from baseline. The primary end point was the first occurence of a CVE, namely ischaemic cerebrovascular disease, ischaemic heart disease and heart failure. Results: The study identified 261 ERA subjects and 783 matched controls. Their characteristics were shown on Table 1. The mean age was 60+/-12 years, 78% were female, 18% were smokers, 8%, 25% and 22% had DM, HT and HL respectively. Table 1. Characteristics of ERA subjects and the matched controls ERA (n=261) Controls (n=783) p-value Age (mean +/- SD ) 60.2 +/- 12 60.3 +/- 12 0.99 Total cholesterol (mean +/- SD ) 4.8 +/- 0.94 4.9 +/- 1.00 0.34 High density lipoprotein-cholesterol (median, IQR ) 1.4 (1.2-1.6) 1.4 (1.2-1.7) 0.612 Low density lipoprotein-cholesterol (mean +/- SD ) 2.8 +/- 0.8 2.6 +/- 0.8 0.27 Triglyceride (median, IQR ) 0.96 (0.7-1.3) 1.2 (0.8-1.7) 0.00 Atherogenic index# (mean +/- SD ) -0.07 +/-0.29 -0.15 +/- 0.28 0.48 RA disease characteristics Baseline last visit Seropositivity 89.3% Disease duration (median days, IQR) 177 (96-299) 2026 (1818-2126) Erythrocyte sedimentation rate (mean +/- SD) 55.7 +/- 34 32.6 +/- 21.3 C-reactive protein (median, IQR) 7.9 (3.5-22.2) 2.1 (1.0-5.0) Swollen joint count (median, IQR) 3 (2-6) 0 (0-1) Tender joint count (median, IQR) 6 (3-10) 0 (0-1) Patient’s global assessment (mean mm +/- SD) 50.7 +/- 26.8 16.0 +/- 18.3 DAS28-ESR (mean +/- SD) 5.2 +/- 1.3 2.4 +/- 1.8 DAS28-CRP (mean +/- SD) 4.4 +/- 1.3 1.8 +/- 1.5 Health assessment questionnaire (mean +/- SD) 0.77 +/- 0.74 0.38 +/- 0.51 # Atherogenic index = log 10 (triglyceride/HDL-cholesterol) SD: standard deviation, IQR: interquartile range, DAS28: disease activity score-28 CVEs occurred in 2.3% ERA subjects and in 3.3% controls. The difference was statistically insignificant. The CVE-free survival was shown in Figure 1. Figure 1. CVE-free survival curves of ERA subjects &amp; matched controls In the ERA cohort, after adjusting for baseline age and atherogenic index, cox-regression analysis showed that i) a longer DAS28 remission duration was protective for CVE with an adjusted hazard ratio (AHR) of 0.46 (95% CI 0.23-0.93), while ii) poor baseline function as reflected by a higher health assessment questionnaire (HAQ) score was predictive of CVE with an AHR of 5.2 (95% CI 1.2-23). Conclusion: ERA patients treated by a T2T strategy did not develop excess CVE compared to CV risk factor-matched controls over 5 years. A longer disease remission duration was protective while a higher baseline HAQ was associated with a higher CVE risk. References: [1]Agca R et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Annals of the Rheumatic Diseases. Disclosure of Interests: None declared