The effect of disease duration and disease activity on the risk of cardiovascular disease in rheumatoid arthritis patients.
OBJECTIVE
Disease duration and disease activity may be associated with an increased risk of cardiovascular disease (CVD) in rheumatoid arthritis (RA). The objectives of this study were to investigate (1) the relationship between duration of inflammation and the development of CVD in RA patients and (2) the relationship between RA disease activity over time and CVD in patients with RA.


METHODS
RA patients with a follow-up of ≥6 months in the Nijmegen early RA cohort without prior CVD were included. Disease activity over time was calculated using the time-averaged  28 joint disease activity score (DAS28) for each patient. Kaplan-Meier survival analysis and Cox proportional hazards regression were used for the analyses.


RESULTS
During follow-up of the 855 patients that were included, 154 CV events occurred. The course of hazards over time did not indicate a change in the risk of CVD over the course of RA (disease duration), which is also reflected by the absence of a deflection in the survival curves. The survival distributions did not differ between patients with a disease duration of <10 years or >10 years (Log-rank test: p=0.82). Time-averaged DAS28 was significantly associated with CVD (p=0.002) after correction for confounders.


CONCLUSIONS
Disease duration does not appear to independently affect the risk of CVD. The risk of CVD in RA patients was not increased after 10 years of disease duration compared with the first 10 years. Disease activity over time may contribute to the risk of CVD.
Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Elke E A
EE
Arts
Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Jaap
J
Fransen
Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
Alfons A
AA
den Broeder
Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Calin D
CD
Popa
Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Piet L C M
PL
van Riel
D054058:Acute Coronary Syndrome / Q000453:epidemiology; D000328:Adult; D000368:Aged; D060050:Angina, Stable / Q000453:epidemiology; D001172:Arthritis, Rheumatoid / Q000453:epidemiology* / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002548:Cerebral Revascularization / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D009426:Netherlands / Q000453:epidemiology; D058729:Peripheral Arterial Disease / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D013997:Time Factors
Cardiovascular Disease; DAS28; Disease Activity; Rheumatoid Arthritis