22 The EULAR 2017 Report
Cardiovascular events in rheumatoid
arthritis have decreased over decades
By Sara Freeman
VIDEO HIGHLIGHTS: Click here to watch a video interview with Prof. Cécile Gaujoux-Viala of
Montpellier University, Nîmes, France.
Recent improvements in the management of rheumatoid arthritis may
have had a positive impact on common cardiovascular comorbidities,
according to the results of a systematic review and meta-analysis.
Risk ratios (RRs) for several CV
events in rheumatoid arthritis (RA)
patients were found to be lower
for data published after 2000 and
up to March 2016 when compared
with data published up until 2000.
Indeed, comparing these two time
periods, French researchers found
that the RRs for myocardial infarction (MI) were a respective 1. 32 and
1. 18, for heart failure a respective
1. 25 and 1. 17, and for CV mortality
a respective 1. 21 and 1.07.
“Systemic inflammation is the
cornerstone of both rheumatoid
arthritis and atherosclerosis,” Prof.
Cécile Gaujoux-Viala, professor of
rheumatology at Montpellier University, Nîmes, France, and chief of
the rheumatology service at Nîmes
University Hospital, said during a
press briefing at the congress.
“Over the past 15 years, new
treatment strategies such as ‘tight
control,’ ‘treat-to-target,’ methotrex-
ate optimisation, and use of bio-
logic DMARDs [disease-modifying
antirheumatic drugs] have led to
better control of this inflammation,”
Prof. Gaujoux-Viala added.
The aim of the meta-analysis was
to look at the overall risk for CV
events in RA patients versus the
general population, she said, as
well as to see if there had been any
temporal shift by analysing data
obtained within two time periods –
before 2000 and after 2000.
A systematic literature review
was performed using the PubMed
and Cochrane Library databases
to search for observational studies
that provided data about the occur-
rence of CV events in RA patients
and controls. Of 5,714 papers that
included reports of stroke, MI, heart
failure, or CV death, 28 had the nec-
essary data for the meta-analysis.
Overall, the 28 studies included
227,871 RA patients, with a mean
age of 55 years.
Results showed that RA patients
had a 17% increased risk for stroke
versus controls overall (P = .002),
with a RR of 1. 17. The RRs were 1. 12
before 2000 and 1. 23 after 2000,
making stroke the only CV event
that did not appear to show a
Compared with the general pop-
ulation, RA patients had a 24%
excess risk of MI, a 22% excess risk
of heart failure, and a 18% excess
risk of dying from a CV event (all P
less than .00001).
These data provide “confirma-
tion of an increased CV risk in RA
patients compared to the general
population,” Prof. Gaujoux-Viala
She had no relevant conflicts of
interest to disclose.