title: Explaining the cardiovascular risk associated with rheumatoid arthritis: traditional risk factors versus markers of rheumatoid arthritis severity.
abstract: BACKGROUND
  Cardiovascular (CV) disease has a major impact on patients with rheumatoid arthritis (RA), however, the relative contributions of traditional CV risk factors and markers of RA severity are unclear. The authors examined the relative importance of traditional CV risk factors and RA markers in predicting CV events.
  
  
  METHODS
  A prospective longitudinal cohort study was conducted in the setting of the CORRONA registry in the USA. Baseline data from subjects with RA enrolled in the CORRONA registry were examined to determine predictors of CV outcomes, including myocardial infarction, stroke or transient ischemic attack. Possible predictors were of two types: traditional CV risk factors and markers of RA severity. The discriminatory value of these variables was assessed by calculating the area under the receiver operating characteristic curve (c-statistic) in logistic regression. The authors then assessed the incidence rate for CV events among subjects with an increasing number of traditional CV risk factors and/or RA severity markers.
  
  
  RESULTS
  The cohort consisted of 10 156 patients with RA followed for a median of 22 months. The authors observed 76 primary CV events during follow-up for a composite event rate of 3.98 (95% CI 3.08 to 4.88) per 1000 patient-years. The c-statistic improved from 0.57 for models with only CV risk factors to 0.67 for models with CV risk factors plus age and gender. The c-statistic improved further to 0.71 when markers of RA severity were also added. The incidence rate for CV events was 0 (95% CI 0 to 5.98) for persons without any CV risk factors or markers of RA severity, while in the group with two or more CV risk factors and three or more markers of RA severity the incidence was 7.47 (95% CI 4.21 to 10.73) per 1000 person-years.
  
  
  CONCLUSIONS
  Traditional CV risk factors and markers of RA severity both contribute to models predicting CV events. Increasing numbers of both types of factors are associated with greater risk.
authors.affiliation: Brigham and Women's Hospital, Boston Massachusetts 02115, USA. dhsolomon@partners.org
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
authors.forename: Joel
authors.initials: J
authors.lastname: Kremer
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.forename: Marc C
authors.initials: MC
authors.lastname: Hochberg
authors.forename: George
authors.initials: G
authors.lastname: Reed
authors.forename: Peter
authors.initials: P
authors.lastname: Tsao
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farkouh
authors.forename: Soko
authors.initials: S
authors.lastname: Setoguchi
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Greenberg
mesh_terms: D000367:Age Factors; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
references.citation: Hypertension. 2007 Jan;49(1):69-75
references.pmid: 17159087
references.citation: Ann Rheum Dis. 2006 Dec;65(12):1608-12
references.pmid: 16793844
references.citation: Ann Rheum Dis. 2009 Aug;68(8):1240-6
references.pmid: 18647854
references.citation: Arthritis Rheum. 2007 Sep;56(9):2905-12
references.pmid: 17763428
references.citation: Arthritis Rheum. 2002 Aug;46(8):2010-9
references.pmid: 12209502
references.citation: J Rheumatol. 2001 May;28(5):982-9
references.pmid: 11361226
references.citation: Am J Med. 2008 Oct;121(10 Suppl 1):S9-14
references.pmid: 18926169
references.citation: Autoimmun Rev. 2006 Jan;5(1):46-54
references.pmid: 16338211
references.citation: J Rheumatol. 2003 Jan;30(1):36-40
references.pmid: 12508387
references.citation: J Rheumatol. 2003 Jul;30(7):1403-5
references.pmid: 12858433
references.citation: Arthritis Rheum. 2005 Oct;52(10):3045-53
references.pmid: 16200609
references.citation: Lancet. 2004 Jun 19;363(9426):2015-21
references.pmid: 15207950
references.citation: Arthritis Rheum. 2008 Sep;58(9):2612-21
references.pmid: 18759273
references.citation: Arthritis Rheum. 2006 Dec;54(12):3790-8
references.pmid: 17136752
references.citation: Circulation. 1998 May 12;97(18):1837-47
references.pmid: 9603539
references.citation: Circulation. 2002 Dec 17;106(25):3143-421
references.pmid: 12485966
references.citation: Circulation. 2003 Mar 11;107(9):1303-7
references.pmid: 12628952
references.citation: Ann Rheum Dis. 2009 Sep;68(9):1395-400
references.pmid: 18697775
references.citation: Arthritis Rheum. 2005 Nov;52(11):3413-23
references.pmid: 16255018
references.citation: J Rheumatol. 2005 Dec;32(12):2311-6
references.pmid: 16331755
references.citation: Circulation. 2007 Feb 20;115(7):928-35
references.pmid: 17309939
references.citation: N Engl J Med. 2008 Nov 20;359(21):2195-207
references.pmid: 18997196
references.citation: Health Serv Res. 1987 Oct;22(4):499-535
references.pmid: 3679841
references.citation: Arthritis Rheum. 2005 Feb;52(2):402-11
references.pmid: 15693010
references.citation: Arthritis Res Ther. 2005;7(4):R796-806
references.pmid: 15987481
references.citation: Circulation. 2002 Oct 22;106(17):2184-7
references.pmid: 12390945
references.citation: J Rheumatol. 2007 May;34(5):943-51
references.pmid: 17444592
references.citation: Lancet. 1999 May 8;353(9164):1547-57
references.pmid: 10334252
references.citation: BMJ. 1994 Jan 8;308(6921):81-106
references.pmid: 8298418
references.citation: Arthritis Res Ther. 2006;8(5):R151
references.pmid: 16984661
references.citation: Clin Exp Rheumatol. 2005 Sep-Oct;23(5 Suppl 39):S100-8
references.pmid: 16273793
references.citation: JAMA. 1993 Jun 16;269(23):3009-14
references.pmid: 8501843
references.citation: Arthritis Rheum. 2005 Aug;52(8):2293-9
references.pmid: 16052597
references.citation: Ann Rheum Dis. 2005 Nov;64(11):1595-601
references.pmid: 15843450
references.citation: Biometrics. 1995 Sep;51(3):1077-84
references.pmid: 7548692
references.citation: Arthritis Rheum. 2003 Jul;48(7):1833-40
references.pmid: 12847676
references.citation: Ann Rheum Dis. 2010 Feb;69(2):325-31
references.pmid: 19773290
references.citation: Lancet. 2002 Apr 6;359(9313):1173-7
references.pmid: 11955534