In Rheumatic Disease, Cardiovascular Risk Peaks Within Year of Diagnosis

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Results of a new study leveraging data from more than 300,000 adult patients in Finland could help improve cardiovascular risk management of patients with rheumatic diseases.

An analysis examining risk of cardiovascular comorbidities before and after the onset of disease in patients with 7 different rheumatic diseases, results offer an overview of the varying cardiovascular risk associated with rheumatic disease, including rheumatoid arthritis, gout, and primary Sjogren’s syndrome.¹

“The risk of [cardiovascular] comorbidities was elevated in all studied rheumatic diseases, with highest risks observed in [systemic lupus erythematous] and gout. The risk for [cardiovascular] diseases was highest immediately before and/or after rheumatic disease diagnosis, highlighting the increased risk for[cardiovascular] comorbidities across all rheumatic diseases very early on the disease course,” wrote investigators.¹

The role of inflammation has become a focal point in discussions across a variety of specialties beyond inflammatory arthritis in recent decades, including cardiology. This evidence by the US Food and Drug Administration’s June 2023 approval of colchicine 0.5 mg (Lodoco) as the first anti-inflammatory indicated for reducing cardiovascular events among adults who have established atherosclerotic cardiovascular disease.²

According to investigators, previous studies have demonstrated patients with rheumatic diseases are at an increased risk of cardiovascular comorbidities, but less research has been dedicated to understanding the timing of diagnosis on risk patterns. With this in mind, a team of investigators Tampere University Hospital and Turku University, both in Finland, designed the current study with the intent of shining further light on risk and temporal relationship between cardiovascular comorbidities in rheumatic diseases through an assessment of data within the FinnGen database.¹

Investigators used the database, which is a collected ofepidemiological cohorts, hospital biobanks, and disease-based cohorts, to assesses the prevalence and risk of cardiovascular comorbidities and their relationship with 7 different forms of rheumatic disease, with subgroup analyses comparing risk across age-, sex-, and birth region-matched controls, among the 321,302 individuals included in the database.¹

The specific diseases of interest for the study were defined as: seropositive rheumatoid arthritis (RA), seronegative RA, ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematous (SLE), primary Sjogren’s syndrome, and gout. For the purpose of analysis, the date of diagnosis of rheumatic or cardiovascular diseases was determined by the first occurrence of diagnosis in the inpatient or outpatient hospital register, with investigators only including those diagnosed at 16 years of age or later and those diagnosed between January 1, 2000 and December 21, 2014.¹

Among the 321,302 individuals included in the FinnGen database, investigators identified 2368 cases of seropositive RA, 916 cases of seronegative RA, 715 cases of AS, 923 cases of PsA, 412 cases of primary Sjogren’s syndrome, 190 cases of SLE, and 2034 cases of gout meeting their inclusion criteria.

Investigators pointed out the median age at the time of diagnosis ranged from 40.4 years (AS) to 65.7 years (gout), and the average duration of follow-up was very similar (11–12 years) in all the rheumatic cohorts except in gout (7.7 years).The most common cardiovascular comorbidity among patients with rheumatic diseases was atrial fibrillation, with prevalence by the end of the follow-up varying from 7.3% (AS) to 45.1% (gout).¹

The primary outcome of interest in the age-, sex-, and birth region-matched analyses was the overall risk ratio (RR) for the prevalence of 7 cardiovascular disease. Investigators also noted an interested in using logistic regression models to estimate odds ratios for cardiovascular comorbidities before and after the onset of rheumatic diseases.¹

Upon analysis, results indicated the risk for any cardiovascular disease was increased across all rheumatic diseases, with the magnitude of risk increase ranging from 14% (RR, 1.14; 95% Confidence interval [CI], 1.02-1.26) to a more than doubling in risk among those with SLE (RR, 2.05; 95% CI, 1.67-2.52). Analysis of risk for individual cardiovascular comorbidities revealed patients with gout or SLE exhibited a more than 2-fold increase in risk for multiple comorbidities. Further analysis suggested the greatest effect size among cardiovascular comorbidities of interest was venous thromboembolism.¹

Additionally, investigators called attention to results of their logistic regression analyses indicating the likelihood of cardiovascular comorbidities was greatest within the year before and/or immediately after the onset of rheumatic disease. However, investigators also called attention to excess risk of cardiovascular disease prior to diagnosis among patients with gout.¹

Investigators called attention to multiple limitations within their study to consider when interpreting results. These included a relatively small number of cases for SLE and primary Sjogren’s syndrome and the inability to perform longitudinal risk analyses for individual cardiovascular disease, among others.¹

“Taken together, our results emphasize the increased risk for [cardiovascular] comorbidities across all rheumatic diseases very early on the disease course and encourages to consider rheumatic diseases as an independent risk factor for [cardiovascular] diseases," investigators wrote.¹

References

1. _{^{Aaramaa HK, Mars N, Helminen M, et al. Risk of cardiovascular comorbidities before and after the onset of rheumatic diseases. Semin Arthritis Rheum. Published online January 26, 2024. doi:10.1016/j.semarthrit.2024.152382}}
2. _{^{Campbell P. FDA approves colchicine tablets for reducing cardiovascular risk. HCP Live. June 20, 2023. Accessed February 14, 2024. https://www.hcplive.com/view/fda-approves-colchicine-tablets-for-reducing-cardiovascular-risk.}}