Incidence and prevalence of major adverse cardiovascular events in rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis

OBJECTIVE The primary objective of this study was to compare the risk of major cardiovascular events (MACE) in a large observational cohort of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA) patients METHODS: We conducted a mixed retrospective and prospective cohort study using data from patients with RA, PsA and axSpA included in the Swiss Clinical Quality Management registry. The primary outcome of interest was a composite of myocardial infarction, transient or permanent cerebrovascular event, or CV associated death. RESULTS 5,315 patients were eligible for the analysis of incidence with a total follow-up time of 37,495 patient years for RA, 19,837 for AxSpA, and 9,171 for PsA. The unadjusted incidence rate of MACE per 1000 person-years was 2.67 for RA, 1.41 for AxSpA, and 1.42 for PsA. Compared to RA patients, unadjusted incidence rate ratio (IRR) were 0.53 for AxSpA (95% confidence interval (CI) 0.34-0.80, p=0.003) and 0.53 for PsA (95% CI 0.30-0.95, p=0.03). After adjustment with traditional CV risk factors, age at disease onset, gender, and disease duration, the difference was not statistically significant between RA and AxSpA (adjusted IRR: 0.93, 95% CI: 0.51-1.69, p=0.80) nor between RA and PsA (adjusted IRR: 0.56, 95% CI: 0.27-1.14, p = 0.11). We found a similar result with the analysis of prevalence. CONCLUSION There was no significant difference in the incidence and prevalence of MACE between RA and AxSpa or PsA, suggesting that inflammation drives the increased risk of CV disease rather than a particular disease. This article is protected by copyright. All rights reserved.