Increased Cardiovascular Risk in Rheumatoid Arthritis Comparable to Diabetes Interview with:
Prof.dr. M.T. Nurmohamed, MD, PhD
Rabia Agca MD
Dept. of Rheumatology | VU University Medical Center
Amsterdam Rheumatology & immunology Center
EULAR center of excellence in rheumatology What is the background for this study?

Response: About 20 years ago the increased mortality in rheumatoid arthritis (RA) was well known, but not the causes. In daily clinical practice it seemed that RA patients more frequently suffered from myocardial infarctions than general population persons. Therefore, we started this study more than 15 years ago as at that time there were only sparse data with respect to cardiovascular morbidity in rheumatoid arthritis. What are the main findings?

Response: We found that cardiovascular events, such as myocardial infarctions, in rheumatoid arthritis were more than doubled as compared to that in the general population. Moreover, the risk was comparable to diabetes, a well-known established cardiovascular risk factor. Hence, in RA there is also a need for cardiovascular risk management, just as in diabetes. What should readers take away from your report?

Response: The present study, which comprises the 15 year follow-up, demonstrates the persistence of this CVD risk during this time period. The increased risk attenuated after adjustment for traditional cardiovascular risk factors but still remained 70% elevated in comparison to the general population, indicating the independent contribution of rheumatoid arthritis itself towards this increased risk. This means that there is a need for attention for this, both by patients as well as the treating rheumatologists. What recommendations do you have for future research as a result of this study?

a) Cardiovascular risk management in RA should target disease activity as well as the traditional cardiovascular risk factors. Unfortunately, despite all the knowledge, the latter is only poorly implemented . Hence, we have just started a more tight implementation project for optimization of cardiovascular risk management.

b) There is accumulating evidence that biologics reduce the cardiovascular risk in rheumatoid arthritis. However, the current strategy of tapering biologics might impose our patients to an increased CVD risk! We aim to conduct some mechanistic studies in this respect.

c) Improvement of current cardiovascular risk prediction models by adding biomarkers Thank you for your contribution to the community.


Increased Risk of Cardiovascular Events in Patients with Rheumatoid Arthritis over a 15 Year Time Period That Is Comparable to Type 2 Diabetes
Rabia Agca1,2, Luuk H.G.A. Hopman2, Vokko P. van Halm3, Mike J.L. Peters4, Jacqueline M. Dekker5, Giel Nijpels5, Coen D.A. Stehouwer6, Yvo M. Smulders4, Alexandre E. Voskuyl1, Maarten Boers1, Willem F. Lems7 and Mike T. Nurmohamed2,8, 1Rheumatology, Amsterdam Rheumatology and immunology Center, Location VU University Medical Center, Amsterdam, Netherlands, 2Rheumatology, Amsterdam Rheumatology and immunology Center, Location Reade, Amsterdam, Netherlands, 3Cardiology, VU University Medical Center, Amsterdam, Netherlands, 4Internal Medicine, VU University Medical Center, Amsterdam, Netherlands, 5EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands, 6Internal Medicine, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands, 7Rheumatology, Amsterdam Rheumatology and immunology Center, location VU University Medical Center, Amsterdam, Netherlands, Amsterdam, Netherlands, 8Rheumatology, Amsterdam Rheumatology and immunology Center, Location VU University Medical Center, Amsterdam, Netherlands, Amsterdam, Netherlands

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on November 16, 2016 by Marie Benz MD FAAD