Disease activity predicts the development of cardiovascular events in patients with rheumatoid arthritis from the CARMA cohort

Llorca, J; Ferraz-Amaro, I; Castañeda, S; Plaza, Z; Sánchez-Alonso, F; García-Gómez, C; González-Juanatey, C; González-Gay, MÁ; CARMA Project Collaborative Group

doi:10.1016/j.semarthrit.2025.152833

Disease activity predicts the development of cardiovascular events in patients with rheumatoid arthritis from the CARdiovascular in RheuMAtology (CARMA) cohort

Semin Arthritis RheumPublished 18 Sep 2025Prospective cohort study

Main finding · CV events: incidence and adjusted risk with moderate/high disease activityResultHazard ratio 1.62 95% CI 1.06–22.47

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Authors' conclusion

Disease activity is a key determinant of CV outcomes in RA patients. The PREVENT-CVD score is an effective tool for CV risk stratification in this population.

Study context

Population: Rheumatoid arthritis (RA) patients without prior cardiovascular (CV) events, recruited from 67 hospitals across Spain (CARMA project), 2010–2012
Participants: 708 patients6,608 patient-years

Exposure: Moderate/high disease activity vs lower disease activity
CV eventsn = 114
Outcome: CV events
Follow-up: 10 years

Methodological detailsmulticentre, 10-year follow-up, Cox regression, crude and adjusted for PREVENT-CVD

Multicentre
10-year follow-up
Cox regression, crude and adjusted for PREVENT-CVD

Main finding

As reported in the abstract

CV events: incidence and adjusted risk with moderate/high disease activity

Hazard ratio

1.62

95% CI 1.06–22.47

P = 0.03

Events by group

CV events

16.1%

114

Moderate/high disease activity (DAS28-ESR>3.2)vs lower disease activity

HR 1.62 (95% CI 1.06–22.47); P = 0.03

Observational data: associations, not effects.

Further findings

Baseline characteristics: age

P < 0.001

CV events70.7 ± 10.6 years

No CV events62.1 ± 12.8 years

Male sex

P < 0.001

CV events36.0%

No CV events20.0%

Hypertension

P < 0.001

CV events46.5%

No CV events23.4%

Diabetes

P = 0.001

CV events14%

No CV events4.9%

Dyslipidemia

P = 0.03

CV events37.7%

No CV events27.4%

Predicted 10-year CV risk (PREVENT-CVD)

P < 0.001

CV events18.0%

No CV events10.3%

Other predictors

Higher baseline erythrocyte sedimentation rate (ESR) associated with future CV events
Higher crude CRP and uric acid associated with increased CV risk; after PREVENT-CVD adjustment associations weakened and became non-significant

Original publication

Disease activity predicts the development of cardiovascular events in patients with rheumatoid arthritis from the CARMA cohort. Semin Arthritis Rheum. Published 18 September 2025. doi:10.1016/j.semarthrit.2025.152833

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