Incidence and outcome of cardiovascular disease in patients with inflammatory joint diseases

Concept

Patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) have a 1.5- to 2-fold increased risk of cardiovascular disease (CVD) compared to the general population. To be able to prevent CVD in patients with inflammatory joint diseases (IJD), it is of great importance to provide up-to-date evidence on the prevalence of CVD and the effect of medication on CVD outcome. The project is conducted within the Norwegian Cardio-Rheuma register, which is a nationwide register linkage study with data on the whole Norwegian population and all patients with RA, PsA and AS from 2008 – 2017, as well as similar Finnish register data.

Facts and Figures

Project Lead
A Kerola
University of Helsinki
anne.kerola@helsinki.fi
FOREUM reserach grant: € 50.000
2020–2021

Meet the Team

Project Lead

A Kerola
University of Helsinki
A Semb
Diakonhjemmet Hospital
M Kauppi
Päijät-Häme Central Hospital
T Nieminen
Päijät-Häme Central Hospital
E Haarvardsholm
Diakonhjemmet Hospital
S Rollefstad
Department of Rheumatology, Diakonhjemmet Hospital
G Wibetoe
Department of Rheumatology, Diakonhjemmet Hospital
A Palomäki
Turku University Hospital
V Kytö
Turku University Hospital

Final Results

Our register-based estimates of RA and PsA incidence in Norway were 42/100,000 person-years and 26/100,000 person-years, respectively. The incidence of RA and PsA was higher among persons with lower education level. Even in the 2010s, Norwegian RA patients suffer from excess all-cause and cardiovascular mortality compared to the general population. In contrast, mortality among PsA patients was similar to the general population. In our Finnish register-linkage study, long-term outcomes after myocardial infarction among patients with RA were impaired compared to the general population. In an international audit exploring cardiovascular disease risk assessment and management among patients with RA in 19 countries, we revealed that although cardiovascular disease and its risk factors were more common among RA patients with diabetes mellitus compared to those without, lipid goals were more frequently obtained among RA patients with diabetes. All in all, our findings warrant more attention to cardiovascular disease prevention in RA patients.

Lay Summary

The goal of this post-doctoral research project was to study the epidemiology of inflammatory joint diseases and related cardiovascular diseases within the Norwegian Cardio-Rheuma Register, which is a newly-established register-linkage study combining data from Norwegian nationwide registers on the entire Norwegian adult population ≥18 yearsbetween 2008and 2017. During this FOREUM-funded post doc year, we have shown that over 1.5% of the Norwegian adult population have RA, PsA or axSpA. Approximately 42 and 26 persons are diagnosed with RA and PsA, respectively, each year in a population of 100,000 adult Norwegians. Even in the 2010s, Norwegian RA patients but not PsA patients had a higher risk of death compared to the general population. The most common causes of death in were cardiovascular disease, malignancies and respiratory disease, and patients with RA had increased risk of death from all of these causes.In a Finnish registry-linkage study, we showed that Finnish RA patients who have suffered a myocardial infarction have a higher risk of death, a new myocardial  infarction,  and  revascularization  compared  to  well-matched  non-RA  patients. In  an international audit among RA patients in 19 countries, we revealed that although cardiovascular disease and its risk factors were more common among RA patients with diabetes mellitus compared to those without, lipid goals were more frequently obtained among RA patients with diabetes. Our findings warrant more attention to cardiovascular disease prevention in RA.

Publications

  • Kerola, A. M., Sexton, J., Wibetoe, G., Rollefstad, S., Crowson, C. S., Mars, N., Kazemi, A., Haavardsholm, E. A., Kvien, T. K., Semb, A. G. (2021). Incidence, sociodemographic factors and treatment penetration of rheumatoid arthritis and psoriatic arthritis in Norway. Seminars in Arthritis and Rheumatism, 51(5), p. 1081-1088. doi: 10.1016/j.semarthrit.2021.08.006
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  • Palomäki A*, Kerola AM*, Malmberg M, Rautava P, Kytö V. Patients with rheumatoid arthritis have impaired long-term outcomes after myocardial infarction - a nationwide case-control
    registry study. Rheumatology (Oxford). 2021 Mar 1:keab204. doi: 10.1093/rheumatology/keab204. Epub ahead of print. PMID: 33667301 *shared first authorship
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  • Semb AG, Rollefstad S, Ikdahl E, Wibetoe G, Sexton J, Crowson C, van Riel P, Kitas G, Graham I, Rantapää-Dahlqvist S, Karpouzas GA, Myasoedova E, Gonzalez-Gay MA, Sfikakis PP, Tektonidou MGG, Lazarini A, Vassilopoulos D, Kuriya B, Hitchon C, Stoenoiu MS, Durez P, Pascual-Ramos V, Galarza-Delgado DA, Faggiano P, Misra DP, Borg AA, Mu R, Mirrakhimov EM, Gheta D, Douglas K, Agarwal V, Myasoedova S, Krougly L, Valentinovna Popkova T, Tuchyňová A, Tomcik M, Vrablik M, Lastuvka J, Horak P, Medkova HK, Kerola AM; SURF-RA collaborators. Diabetes mellitus and cardiovascular risk management in patients with rheumatoid arthritis: an international audit. RMD Open 2021; 7:e001724. doi: 10.1136/rmdopen-2021-001724
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  • Kerola, A. M., Rollefstad, S., & Semb, A. G. (2021). Atherosclerotic Cardiovascular Disease in Rheumatoid Arthritis: Impact of Inflammation and Antirheumatic Treatment. European cardiology, 16, e18. https://doi.org/10.15420/ecr.2020.44
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  • Kerola AM, Palomäki A, Rautava P, Nuotio M, Kytö V. (2021). Sex Differences in Cardiovascular Outcomes of Older Adults after Myocardial Infarction. Journal of the American Heart Association. doi: 10.1161/JAHA.121.022883.
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  • Kerola, A. M., Sexton, J., Wibetoe, G., Rollefstad, S., Crowson, C. S., Mars, N., Kazemi, A., Haavardsholm, E. A., Kvien, T. K., Semb, A. G. (2021). Incidence, sociodemographic factors and treatment penetration of rheumatoid arthritis and psoriatic arthritis in Norway. Seminars in Arthritis and Rheumatism, 51(5), p. 1081-1088. doi: 10.1016/j.semarthrit.2021.08.006
    Read more
  • Kerola AM, Rollefstad S, Kazemi A, Wibetoe G, Sexton J, Mars NJ, Kauppi M, Kvien TK, Haavardsholm EA, Semb AG (2022) Psoriatic arthritis, axial spondyloarthritis and rheumatoid arthritis in Norway: nationwide prevalence and use of biologic agents, Scandinavian Journal of Rheumatology, DOI: 10.1080/03009742.2021.1997436
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EULAR Abstracts

2021

  • POS0029 Incidence and treatment penetration of rheumatoid arthritis in Norway – a nationwide register linkage study
  • POS1041 Prevalence, incidence and antirheumatic drug use in psoriatic arthritis (PsA) in Norway

Project Map