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Effect of a treat-to-target intervention of cardiovascular risk factors on subclinical and clinical atherosclerosis in rheumatoid arthritis: a randomised clinical trial.
- Source :
-
Annals of the rheumatic diseases [Ann Rheum Dis] 2019 Mar; Vol. 78 (3), pp. 335-341. Date of Electronic Publication: 2019 Jan 04. - Publication Year :
- 2019
-
Abstract
- Background: Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD). No long-term intervention trials on CVD risk factors have been published, and a debate on the efficacy of controlling traditional risk factors in RA is ongoing. We aimed to evaluate a treat-to-target approach versus usual care regarding traditional CVD risk factors in patients with RA.<br />Methods: In this open-label, randomised controlled trial, patients with RA aged <70 years without prior CVD or diabetes mellitus were randomised 1:1 to either a treat-to-target approach or usual care of traditional CVD risk factors. The primary outcome was defined as change in carotid intima media thickness (cIMT) over 5 years, and the secondary outcome was a composite of first occurrence of fatal and non-fatal cardiovascular events.<br />Results: A total of 320 patients (mean age 52.4 years; 69.7% female) with RA underwent randomisation and 219 patients (68.4%) completed 5 years of follow-up. The mean cIMT progression was significantly reduced in the treat-to-target group compared with usual care (0.023 [95% CI 0.011 to 0.036] mm vs 0.045 [95% CI 0.030 to 0.059] mm; p=0.028). Cardiovascular events occurred in 2 (1.3%) of the patients in the treat-to-target group vs 7 (4.7%) in those receiving usual care (p=0.048 by log-rank test).<br />Conclusion: This study provides evidence on the benefit of a treat-to-target approach of traditional CVD risk factors for primary prevention in patients with well-treated RA.<br />Trial Registration Number: NTR3873.<br />Competing Interests: Competing interests: MCC served as a consultant for Merck and received lecture honoraria from Merck.<br /> (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)
- Subjects :
- Adult
Aged
Arthritis, Rheumatoid complications
Arthritis, Rheumatoid physiopathology
Carotid Intima-Media Thickness
Disease Management
Disease Progression
Female
Humans
Male
Middle Aged
Patient Care Planning
Risk Factors
Severity of Illness Index
Treatment Outcome
Antirheumatic Agents administration & dosage
Arthritis, Rheumatoid drug therapy
Atherosclerosis etiology
Cardiovascular Diseases etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1468-2060
- Volume :
- 78
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Annals of the rheumatic diseases
- Publication Type :
- Academic Journal
- Accession number :
- 30610067
- Full Text :
- https://doi.org/10.1136/annrheumdis-2018-214075