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Biological use influences the impact of inflammation on risk of major adverse cardiovascular events in rheumatoid arthritis

Abstract: Objectives: Chronic inflammation promotes cardiovascular risk in rheumatoid arthritis (RA). Biological disease-modifying antirheumatic drugs (bDMARDs) improve disease activity and cardiovascular disease outcomes. We explored whether bDMARDs influence the impact of disease activity and inflammatory markers on long-term cardiovascular risk in RA. Methods: We studied 4370 participants without cardiovascular disease in a 10-country observational cohort of patients with RA. Endpoints were (1) major adverse cardiovascular events (MACE) encompassing myocardial infarction, stroke and cardiovascular death; and (2) any ischaemic cardiovascular events (iCVE) including MACE plus revascularisation, angina, transient ischaemic attack and peripheral arterial disease. Results. Over 26?534 patient-years, 239 MACE and 362 iCVE occurred. The interaction between 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) and bDMARD use was significant for MACE (p=0.017), suggesting the effect of DAS28-CRP on MACE risk differed among bDMARD users (n=515) and non-users (n=3855). DAS28-CRP (per unit increase) is associated with MACE risk in bDMARD non-users (HR 1.21 (95% CI 1.07 to 1.37)) but not users (HR 0.69 (95% CI 0.40 to 1.20)). The interaction between CRP (per log unit increase) and bDMARD use was also significant for MACE (p=0.011). CRP associated with MACE risk in bDMARD non-users (HR 1.16 (95% CI 1.04 to 1.30)), but not users (HR 0.65 (95% CI 0.36 to 1.17)). No interaction was observed between bDMARD use and DAS28-CRP (p=0.167) or CRP (p=0.237) for iCVE risk. Conclusions. RA activity and inflammatory markers associated with risk of MACE in bDMARD non-users but not users suggesting the possibility of biological-specific benefits locally on arterial wall independently of effects on systemic inflammation.

 Fuente: RMD open, 2024, 10, e004546

 Publisher: BMJ Publishing Group

 Year of publication: 2024

 No. of pages: 9

 Publication type: Article

 DOI: 10.1136/rmdopen-2024-004546

 ISSN: 2056-5933

 Publication Url: https://doi.org/10.1136/rmdopen-2024-004546

Authorship

KARPOUZAS, GEORGE ATHANASIOS

ORMSETH, SARAH R.

VAN RIEL, PIEL LEONARDUS CORNELIS MARIA

ALFONSO FERNANDO CORRALES MARTINEZ

RANTAPÄÄ-DAHLQVIST, SOLBRITT

SFIKAKIS, PETROS P.

DESSEIN, PATRICK

TSANG, LINDA

HITCHON, CAROL

EL-GABALAWY, HANI

PASCUAL-RAMOS, VIRGINIA

CONTRERAS-YÁÑEZ, IRAZÚ

COLUNGA-PEDRAZA, IRIS, J.

GALARZA-DELGADO, DIONICIO ANGEL

AZPIRI-LÓPEZ, JOSÉ RAMÓN

SEMB, ANNE GRETE

MISRA, DURGA PRASANNA

HAUGE, ELLEN-MARGRETHE

KITAS, GEORGE