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Five-year cardiovascular event risk in early rheumatoid arthritis patients who received treat-to-target management: a case-control study

Objectives: This study explored whether the excess cardiovascular (CV) disease (CVD) risk in rheumatoid arthritis (RA) could be ameliorated by suppression of inflammation using a treat-to-target (T2T) approach. We compared the CV event (CVE) incidence among ERA patients managed by a T2T strategy with a CV risk factor-matched non-RA population and a historical RA cohort (HRA).

Methods: This was an observational study using the city-wide hospital data & the ERA registry. ERA patients received T2T management while HRA patients received routine care. Each ERA/HRA patient was matched to 3 non-RA controls according to age, gender and CV risk factors. Patients on antiplatelet/anticoagulant agents, with pre-existing CVD, chronic kidney disease or other autoimmune diseases were excluded. All subjects were followed for up to 5 years. The primary end point was the first occurrence of a CVE.

Results: The incidence of CVE in the ERA cohort (n = 261) & ERA-controls were similar with a hazard ratio of 0.53 (95% confidence interval [CI] 0.15-1.79). In contrast, the incidence of CVE in the HRA cohort (n = 268) was significantly higher than that of the HRA-controls with a hazard ratio of 1.9 (95% CI 1.16-3.13). The incidence of CVE in the ERA cohort was significantly lower than that of the HRA cohort and the difference became insignificant after adjusting for inflammation, the use of methotrexate and traditional CV risk factors.

Conclusion: ERA patients managed by a T2T strategy did not develop excess CVE compared with CV risk factor-matched controls over 5 years.

Comments：

This observational study found that rheumatoid arthritis patients managed with a treat-to-target strategy had a similar incidence of cardiovascular events compared to controls with similar risk factors, while the incidence of events was significantly higher in a historical cohort of rheumatoid arthritis patients managed with routine care.

 

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