Biological use influences the impact of inflammation on risk of major adverse cardiovascular events in rheumatoid arthritis
Authors' conclusion
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.
Study context
- Population
- Patients with rheumatoid arthritis (RA) without CVD in a 10-country observational cohort
- Participants
- 4,370 patients26,534 patient-years
- Exposure
- Effect of disease activity and inflammatory markers on CV risk in bDMARD users vs non-users
- bDMARD usersn = 515
- bDMARD non-usersn = 3,855reference
- Outcome
- (1) MACE (MI, stroke, CV death); (2) any ischaemic CV events (iCVE: MACE plus revascularisation, angina, TIA, peripheral arterial disease)
Methodological detailsobservational, 10-country, interaction analysis
- Observational
- 10-country
- Interaction analysis
Main finding
As reported in the abstract
MACE per unit increase in DAS28-CRP, by bDMARD use
Hazard ratio (95% CI)
DAS28-CRP per unit increase, bDMARD non-users
1.21(1.07–1.37)
DAS28-CRP per unit increase, bDMARD users
0.69(0.40–1.20)
Per unit increase, as printed
- Interaction Disease Activity Score with C-reactive protein (DAS28-CRP) × bDMARD use for major adverse cardiovascular events (MACE)
- P = 0.017
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| MACE per log unit increase in CRP, by bDMARD usebDMARD non-users · CRP associated with MACE risk | 1.16 (1.04–1.30) | |
| MACE per log unit increase in CRP, by bDMARD usebDMARD users · not associated | 0.65 (0.36–1.17) | |
| 0.20.5125Hazard ratio (log scale) |
- MACE per log unit increase in CRP, by bDMARD use — Interaction between CRP (per log unit increase) and bDMARD use for MACE
- p=0.011
Ischaemic cardiovascular events (iCVE): interaction between bDMARD use and DAS28-CRP or CRP
- No interaction between bDMARD use and DAS28-CRP for iCVE
- P = 0.167
- No interaction between bDMARD use and CRP for iCVE
- P = 0.237
Original publication
Biological use influences the impact of inflammation on risk of major adverse cardiovascular events in rheumatoid arthritis. RMD Open. Published 23 July 2024. doi:10.
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