1. Biological use influences the impact of inflammation on risk of major adverse cardiovascular events in rheumatoid arthritis.
- Author
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Karpouzas, George, Ormseth, Sarah, van Riel, Piet, Gonzalez-Gay, Miguel, Corrales, Alfonso, Rantapää-Dahlqvist, Solbritt, Sfikakis, Petros, Dessein, Patrick, Tsang, Linda, Hitchon, Carol, El-Gabalawy, Hani, Pascual-Ramos, Virginia, Contreras-Yáñez, Irazú, Colunga-Pedraza, Iris, Galarza-Delgado, Dionicio, Azpiri-Lopez, Jose, Semb, Anne, Misra, Durga, Hauge, Ellen-Margrethe, and Kitas, George
- Subjects
Arthritis ,Rheumatoid ,Biological Therapy ,Cardiovascular Diseases ,Inflammation ,Humans ,Arthritis ,Rheumatoid ,Male ,Female ,Middle Aged ,Antirheumatic Agents ,Cardiovascular Diseases ,Inflammation ,Aged ,Biomarkers ,C-Reactive Protein ,Risk Factors ,Severity of Illness Index - Abstract
OBJECTIVES: Chronic inflammation promotes cardiovascular risk in rheumatoid arthritis (RA). Biological disease-modifying antirheumatic drugs (bDMARDs) improve disease activity and cardiovascular disease outcomes. We explored whether bDMARDs influence the impact of disease activity and inflammatory markers on long-term cardiovascular risk in RA. METHODS: We studied 4370 participants without cardiovascular disease in a 10-country observational cohort of patients with RA. Endpoints were (1) major adverse cardiovascular events (MACE) encompassing myocardial infarction, stroke and cardiovascular death; and (2) any ischaemic cardiovascular events (iCVE) including MACE plus revascularisation, angina, transient ischaemic attack and peripheral arterial disease. RESULTS: Over 26 534 patient-years, 239 MACE and 362 iCVE occurred. The interaction between 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) and bDMARD use was significant for MACE (p=0.017), suggesting the effect of DAS28-CRP on MACE risk differed among bDMARD users (n=515) and non-users (n=3855). DAS28-CRP (per unit increase) is associated with MACE risk in bDMARD non-users (HR 1.21 (95% CI 1.07 to 1.37)) but not users (HR 0.69 (95% CI 0.40 to 1.20)). The interaction between CRP (per log unit increase) and bDMARD use was also significant for MACE (p=0.011). CRP associated with MACE risk in bDMARD non-users (HR 1.16 (95% CI 1.04 to 1.30)), but not users (HR 0.65 (95% CI 0.36 to 1.17)). No interaction was observed between bDMARD use and DAS28-CRP (p=0.167) or CRP (p=0.237) for iCVE risk. CONCLUSIONS: RA activity and inflammatory markers associated with risk of MACE in bDMARD non-users but not users suggesting the possibility of biological-specific benefits locally on arterial wall independently of effects on systemic inflammation.
- Published
- 2024