Cardiovascular risk in patients with rheumatoid arthritis: assessment of several traditional risk parameters and a German risk score model

Abstract

The present cross-sectional data demonstrate cardiovascular (CV) risk in patients with rheumatoid arthritis (RA). The cross-sectional data were part of an interventional trial that included 100 patients with defined RA. Traditional CV risk parameters and risk score calculation for the German population were used to assess the CV risk profile in the collective given. Proatherogenic lipid profile characterised by increased total cholesterol (≥5.2 mmol/l) and LDL cholesterol (≥3.5 mmol/l) levels was measured in 85 and 66%, respectively, of the study population. Elevated concentrations of homocysteine (≥10 μmol/l) were reached by 67%. The prevalence of patients at high CV risk was 12% and increased up to 42% after using a multiplication factor of 1.5. No association was seen between the CV risk SCORE and DAS 28 or disease duration. RA patients in this study showed a proatherogenic risk profile with regard to the CV risk factors evaluated. The calculation of a 10-year risk using German risk charts might have led to an overall underestimation of the mean CV risk. Cardiovascular co-morbidity in RA patients must be seen as a major prevention and treatment target and should be monitored adequately.

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References

  1. 1.

    Weyand CM (2000) New insights into the pathogenesis of rheumatoid arthritis. Rheumatology (Oxford) 39(Suppl 1):3–8

    Article  Google Scholar 

  2. 2.

    Scott DL, Wolfe F, Huizinga TW (2010) Rheumatoid arthritis. Lancet 376:1094–1108

    PubMed  Article  Google Scholar 

  3. 3.

    Kapetanovic MC, Lindqvist E, Simonsson M, Geborek P, Saxne T, Eberhardt K (2010) Prevalence and predictive factors of comorbidity in rheumatoid arthritis patients monitored prospectively from disease onset up to 20 years: lack of association between inflammation and cardiovascular disease. Scand J Rheumatol 39:353–359

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Solomon DH, Karlson EW, Rimm EB et al (2003) Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation 107:1303–1307

    PubMed  Article  Google Scholar 

  5. 5.

    Goodson N, Marks J, Lunt M, Symmons D (2005) Cardiovascular admissions and mortality in an inception cohort of patients with rheumatoid arthritis with onset in the 1980s and 1990s. Ann Rheum Dis 64:1595–1601

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Avina-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D (2008) Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum 59:1690–1697

    PubMed  Article  Google Scholar 

  7. 7.

    del Rincon I, Williams K, Stern MP, Freeman GL, Escalante A (2001) High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum 44:2737–2745

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Chung CP, Oeser A, Raggi P et al (2005) Increased coronary-artery atherosclerosis in rheumatoid arthritis: relationship to disease duration and cardiovascular risk factors. Arthritis Rheum 52:3045–3053

    PubMed  Article  Google Scholar 

  9. 9.

    Aubry MC, Maradit-Kremers H, Reinalda MS, Crowson CS, Edwards WD, Gabriel SE (2007) Differences in atherosclerotic coronary heart disease between subjects with and without rheumatoid arthritis. J Rheumatol 34:937–942

    PubMed  CAS  Google Scholar 

  10. 10.

    Wolfe F, Michaud K (2008) The risk of myocardial infarction and pharmacologic and non pharmacologic myocardial infarction predictors in rheumatoid arthritis: a cohort and nested case-control analysis. Arthritis Rheum 58:2612–2621

    PubMed  Article  Google Scholar 

  11. 11.

    Atzeni F, Turiel M, Caporali R et al (2010) The effect of pharmacological therapy on the cardiovascular system of patients with systemic rheumatic diseases. Autoimmun Rev 9:835–839

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Peters M, Symmons D, McCarey D et al (2010) EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 69:325–331

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Bacon PA, Townend JN (2001) Nails in the coffin: increasing evidence for the role of rheumatic disease in the cardiovascular mortality of rheumatoid arthritis. Arthritis Rheum 44:2707–2710

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Grundy SM, Pasternak R, Greenland P, Smith S Jr, Fuster V (1999) Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Circulation 100:1481–1492

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB (1998) Prediction of coronary heart disease using risk factor categories. Circulation 97:1837–1847

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Assmann G, Cullen P, Schulte H (2002) Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation 105:310–315

    PubMed  Article  Google Scholar 

  17. 17.

    Assmann G (2005) Assessment of cardiovascular risk—PROCAM and new algorithms. Biomed Tech (Berl) 50:227–232

    Article  CAS  Google Scholar 

  18. 18.

    Conroy RM, Pyorala K, Fitzgerald AP et al (2003) Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 24:987–1003

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Keil U, Fitzgerald A, Gohlke H, Wellmann J, Hense H (2005) Risk stratification of cardiovascular diseases in primary prevention—the new SCORE-deutschland risk charts. Deutsches Ärzteblatt 102:A1808–A1812

    Google Scholar 

  20. 20.

    Willers J, Fasse S, Putschky N et al (2011) Combined add-on supplementation of omega-3 fatty acids, vitamin E, vitamin A, copper, and selenium in rheumatoid arthritis. Food Nutr Sci 2:714–723

    Article  CAS  Google Scholar 

  21. 21.

    Chobanian AV, Bakris GL, Black HR et al (2003) the seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 289:2560–2572

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Chobanian AV, Bakris GL, Black HR et al (2003) Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42:1206–1252

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    International Task Force for Prevention of Coronary Heart Disease (1998) Coronary heart disease: reducing the risk. Nutr Metab Cardiovasc Dis 8:271

    Google Scholar 

  24. 24.

    Boyer JF, Gourraud PA, Cantagrel A, Davignon JL, Constantin A (2011) Traditional cardiovascular risk factors in rheumatoid arthritis: a meta-analysis. Joint Bone Spine 78:179–183

    PubMed  Article  Google Scholar 

  25. 25.

    Santos MJ, Vinagre F, Silva JJ, Gil V, Fonseca JE (2010) Cardiovascular risk profile in systemic lupus erythematosus and rheumatoid arthritis: a comparative study of female patients. Acta Reumatol Port 35:325–332

    PubMed  Google Scholar 

  26. 26.

    Dursunoglu D, Evrengul H, Polat B et al (2005) Lp(a) lipoprotein and lipids in patients with rheumatoid arthritis: serum levels and relationship to inflammation. Rheumatol Int 25:241–245

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Popa C, Netea MG, Radstake T et al (2005) Influence of anti-tumour necrosis factor therapy on cardiovascular risk factors in patients with active rheumatoid arthritis. Ann Rheum Dis 64:303–305

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Kofler S, Nickel T, Weis M (2005) Role of cytokines in cardiovascular diseases: a focus on endothelial responses to inflammation. Clin Sci (Lond) 108:205–213

    Article  CAS  Google Scholar 

  29. 29.

    Khovidhunkit W, Kim MS, Memon RA et al (2004) Effects of infection and inflammation on lipid and lipoprotein metabolism: mechanisms and consequences to the host. J Lipid Res 45:1169–1196

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Pahor A, Hojs R, Gorenjak M, Rozman B (2006) Accelerated atherosclerosis in pre-menopausal female patients with rheumatoid arthritis. Rheumatol Int 27:119–123

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Crowson CS, Nicola PJ, Kremers HM et al (2005) How much of the increased incidence of heart failure in rheumatoid arthritis is attributable to traditional cardiovascular risk factors and ischemic heart disease? Arthritis Rheum 52:3039–3044

    PubMed  Article  Google Scholar 

  32. 32.

    Bahadursingh S, Beharry K, Maharaj K et al (2009) C-reactive protein: adjunct to cardiovascular risk assessment. West Indian Med J 58:551–555

    PubMed  CAS  Google Scholar 

  33. 33.

    Sandoo A, Veldhuijzen van Zanten JJ, Metsios GS, Carroll D, Kitas GD (2011) Vascular function and morphology in rheumatoid arthritis: a systematic review. Rheumatology (Oxford)

  34. 34.

    Sarwar AB, Sarwar A, Rosen BD, Nasir K (2007) Measuring subclinical atherosclerosis: is homocysteine relevant? Clin Chem Lab Med 45:1667–1677

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Hornung N, Ellingsen T, Stengaard-Pedersen K, Poulsen JH (2004) Folate, homocysteine, and cobalamin status in patients with rheumatoid arthritis treated with methotrexate, and the effect of low dose folic acid supplement. J Rheumatol 31:2374–2381

    PubMed  CAS  Google Scholar 

  36. 36.

    Landewe RB, van den Borne BE, Breedveld FC, Dijkmans BA (2000) Methotrexate effects in patients with rheumatoid arthritis with cardiovascular comorbidity. Lancet 355:1616–1617

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Naz SM, Symmons DP (2007) Mortality in established rheumatoid arthritis. Best Pract Res Clin Rheumatol 21:871–883

    PubMed  Article  Google Scholar 

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Acknowledgments

We specially thank all partners and co-operating medical practices who helped with the study procedure: Dr. Sabine Fasse, Dr. Nils Putschky, Prof. Dr. Henning Zeidler, Dr. Hans-Georg Pott, Dr. Michael Bernateck, Dr. Winfried Demary, Walburga Reichard, Christiane Heuermann, Dr. Reinhard Hein, Dr. Hannah Frank, Dr. Vu Vi Pham, Dr. Rainer Stange, Dr. Bernhard Uehleke, Larissa Meier, Sabine Saalfeld, Dr. Heike Franziska Weidemann, Dr. Guido Hoese, Prof. Dr. Ralf Lichtinghagen, Heike Kohrs, and Gudrun Gläser.

Conflict of interest

The authors declare that they have no financial or other conflict of interest relevant to the subject of this article.

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Correspondence to Janina Willers.

Additional information

This analysis was part of an interventional trial supported by Opfermann Arzneimittel GmbH, Wiehl, Germany—Rottapharm|Madaus Group.

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Willers, J., Hahn, A. Cardiovascular risk in patients with rheumatoid arthritis: assessment of several traditional risk parameters and a German risk score model. Rheumatol Int 32, 3741–3749 (2012). https://doi.org/10.1007/s00296-011-2238-7

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Keywords

  • Rheumatoid arthritis
  • Cardiovascular risk
  • Cardiovascular risk factors
  • Risk score models
  • SCORE Germany