New Milestone in Cardiovascular Disease Management for People with Rheumatoid Arthritis

Rheumatoid arthritis is the most common chronic autoimmune disease that affects the joints. RA has the potential for joint damage and deformity, with loss of function. The cause of RA is unknown. It affects people of all ages, and women more commonly than men. RA causes pain, stiffness and swelling, generally in multiple joints. RA may affect any joint, but the small joints in the hands and feet are most frequently involved.

Rheumatoid arthritis has been associated with an increase in cardiovascular disease and cardiovascular death when patients are compared to people without the disease. "During the previous decades, there has been no apparent signal for this increased cardiovascular risk to be declining," says lead investigator in the study, Elena Myasoedova, MD, PhD; assistant professor of medicine, Department of Internal Medicine, Mayo Clinic. "Very few studies thus far looked at risk for cardiovascular death in people who have been recently diagnosed with RA, and it remained unclear whether the risk is changing in the era of improved diagnostics and early effective treatments."

Dr. Myasoedova's team assessed cardiovascular disease death trends among 315 people who developed RA between 2000 and 2007 and compared these to trends among 498 people who developed RA earlier as well as to 813 people without the disease. Sixty-eight percent of people in the study were female, with an average age of nearly 60 years.

All participants were followed until their deaths, or if they moved, or January 1, 2014. The researchers obtained causes of death from state and local death certificates as well as the National Death Index Plus and grouped them according to corresponding medical diagnosis codes to identify trends.

The researchers noted that the 10-year overall incidence of cardiovascular disease deaths among participants diagnosed with RA between 2000 and 2007 was 2.8 percent. More specifically, the rate for coronary heart disease deaths among this group was 1.2 percent. These are significantly better than estimates for cardiovascular death and coronary heart disease deaths in those diagnosed between 1990 and 1999 (7.9 and 4.7 percent, respectively), suggesting an improvement in cardiovascular death rate by 57 percent and in coronary heart disease and by about 80 percent in patients diagnosed in 2000-2007 versus 1990-1999.

Additionally, the researchers discovered that deaths from cardiovascular disease, and specifically coronary heart disease, in the participants diagnosed between 2000 and 2007 did not differ from people in the study who didn't have RA, which has not been reported in earlier decades. This leads Dr. Myasoedova's team to believe that there has been a significant improvement in the risk of death from cardiovascular disease in patients with RA over the recent years, and the risk is now comparable to that in the general population.

"Potential contributors to these improving trends are unknown, but may include improved diagnostics, early effective treatments currently available for patients with RA, and increased awareness and improved management of increased cardiovascular disease risk in RA," Dr. Myasoedova explains. "While the reasons for the recent improvement in cardiovascular mortality in RA are uncertain, continued efforts towards early diagnosis and early effective antirheumatic treatment, as well as more vigilant cardiovascular screening and management according to current guidelines of cardiovascular disease management in RA, appear to be justified and are likely to be beneficial to people with this disease."

Dr. Myasoedova's research team continues to investigate the reasons for the recent improvement in cardiovascular death in RA, as understanding the underlying nature for this improvement may aid in improving cardiovascular risk management not only in RA but also in the general population.