Cardiovascular disease as a risk factor for development of rheumatoid arthritis – a danish follow-up study

Asta Linauskas, Annette de Thurah, Martin Berg Johansen, Kristian Stengaard-Pedersen, Kim Overvad

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Background It is well-established that patients with rheumatoid arthritis (RA) have higher risk for development of atherosclerotic cardiovascular diseases (CVD) than the general population (1). The evidence shows that a CVD burden is already notable at the onset of RA (2). It is well-known, that atherosclerosis is an inflammatory condition (3). Therefore, we hypothesize that atherosclerotic CVD is positively associated with subsequent development of RA.Objectives To examine the risk of developing RA in persons who have had CVD, defined as acute myocardial infarction (AMI) or ischaemic stroke while controlling for established shared risk factors.Methods We conducted a population-based cohort study within the Danish Diet, Cancer and Health (DCH) cohort. The cohort was recruited 1993-97 and included individuals aged 50 to 64 years, born in Denmark and living in geographically defined parts of Denmark. Data on lifestyle factors and anthropometric measurements were collected at enrolment into the DCH. Information on incident AMI (ICD-10 code: I21), ischemic stroke (ICD-10 code: I63) and RA (ICD-10 codes: M05, M06 combined with ATC codes for DMARDs) was obtained from nationwide administrative registers. Participants were followed until development of RA, death, loss to follow-up or October 2016, whichever came first. Data were analyzed using Cox’s proportional hazards regression models with delayed entry and age as the underlying time scale and cardiovascular disease (CVD) as a time-varying exposure variable, stratifying by gender. Established shared risk factors - smoking, body mass index and waist circumference - were included in the multivariable analyses.Results Complete data were available on 53287 subjects (52% female) without a AMI, stroke or RA diagnosis prior to their enrolment into the DCH. Median age at entry into DCH was 56 years. During follow-up (median 21 years), 4,627 participants developed CVD (37% female) and 516 participants developed RA (69% female). The risk for developing RA was 30% higher in women with CVD than in women without CVD (adjusted hazard ratio (HR) 1.30 (95% CI 0.70-2.38)) (Table 1). In men, there was no clear association between CVD and development of RA (adjusted HR 0.73 (95% CI 0.34-1.58)).View this table:Table 1 The relationship between cardiovascular disease and the development of rheumatoid arthritis, stratified by gender.Conclusion The investigation showed tendency towards a higher risk of developing RA in women with previous CVD than women without CVD. Male gender was not associated with subsequent development of RA, possibly related to low sample size.References [1] Avina-Zubieta et al. Ann Rheum Dis. 2012;71(9):1524–9.[2] Hannawi et al. Arthritis Res Ther. 2007;9(6):R116.[3] Ross R. N Engl J Med. 1999 Jan 14;340(2):115–26Disclosure of Interests None declared
Original languageEnglish
Article numberTHU0673
JournalAnnals of the Rheumatic Diseases
Issue numberSuppl. 2
Pages (from-to)632-633
Number of pages2
Publication statusPublished - Jun 2019
EventAnnual European Congress of Rheumatology, EULAR 2019 - Madrid, Spain
Duration: 12 Jun 201915 Jun 2019


ConferenceAnnual European Congress of Rheumatology, EULAR 2019
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