2005;23(5 Suppl 39):S100CS108
2005;23(5 Suppl 39):S100CS108. We then assessed the incidence rate for CV events among subjects with an increasing number of traditional CV risk factors and/or RA severity markers. Results The cohort consisted of 10,156 patients with RA followed for a median of 22 months. We observed 76 primary CV events during follow-up for a composite event rate of 3.98 (95% CI 3.08 C 4.88) per 1,000 patient-years. The c-statistic improved from 0.57 for models with only CV risk factors to 0.67 for models with CV risk factors plus age and gender. The c-statistic improved further to 0.71 when markers Alexidine dihydrochloride of RA severity were also added. The incidence rate for Alexidine dihydrochloride CV events was 0 (95% CI 0 C 5.98) for persons without any CV risk factors or markers of RA severity, while in the group with two or more CV risk factors and 3 or more markers of RA severity the incidence was 7.47 (95% CI 4.21C10.73) per 1,000 person-years. Conclusions Traditional CV risk factors and markers of RA severity both contribute to models predicting CV events. Increasing numbers of both types of factors are associated with greater risk. INTRODUCTION Cardiovascular (CV) disease represents a major source of morbidity and mortality for patients with RA.1C4 Myocardial infarction (MI) and stroke are common events and thus difficult for a single clinician to associate with a given disease, such as RA. However, a series of large epidemiologic studies over the last several decades strongly support an elevation in CV risk with RA.3, 4 These studies have come from both community-based and referral populations, and consistently find that RA patients have a 1.5 to 3-fold increased risk for CV events compared with non-RA controls. In addition to the increased risk of CV events in RA, silent cardiac ischemia and fatal CV presentations may be more common in RA than in non-RA subjects. 5C7 In spite of the clear association between CV events and RA, elucidating the link between these conditions has been challenging. Some, but not all, studies suggest that the heightened CV risk is mediated by an effect of RA on traditional CV risk factors, such as hyperlipidemia and insulin resistance. 8C10 Other data demonstrate that markers of RA severity associate with surrogate markers of CV risk; for example, elevated acute phase reactants correlate with an increased carotid intima medial thickness.11 In patients with new onset inflammatory polyarthritis, CRP levels are directly related to risk of death. 12 Other results have also supported the relationship between RA disease activity and CV risk.13 There are also data suggesting an association between rheumatoid factor (RF) and CV events.14 Some medications used for RA have been linked with CV risk C glucocorticoids and nonsteroidal anti-inflammatory drugs. However, these agents do not appear to completely explain the CV risk associated with RA.13, 15, 16 Several prior studies have demonstrated an association between CV risk factors, markers of RA severity and atherosclerosis. 17 18 These studies have been consistent in their findings, but none have used actual CV events as an outcome. A more complete understanding of risk factors for CV events Alexidine dihydrochloride in RA will facilitate development and testing of intervention strategies. On a population level, better control of traditional CV risk factors will likely lead to fewer CV events in RA, but it is unclear whether a strategy of enhanced control of RA disease activity will also CTMP lead to reduced CV risk. Moreover, there is no information on the relative importance of Alexidine dihydrochloride targeting traditional CV risk factors versus markers of RA severity to affect CV risk. We thus examined the relative importance of baseline traditional CV risk factors compared with baseline markers of RA severity to determine their relative predictive value for CV events in a very large longitudinal cohort. This work was guided by the hypothesis that both sets of factors would add independent predictive value to models of CV events among patients with RA. METHODS Study Cohort We examined data from CORRONA, the Consortium of Rheumatology Researchers of North America. Since 2002, CORRONA has enrolled over 17,000 patients with RA through 268 participating academic and community rheumatologists at 103 sites in the United States. Rheumatologists and their staff receive training on patient recruitment and form completion. They are reimbursed for the collection of data at the time of the routine clinical encounter on consecutive patients in a prospective manner. For the purposes of the.