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.
Project LeadA Kerola
The results from this project may facilitate the establishment of CVD prevention recommendations/guidelines specifically developed for patients with IJD.
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.
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 years between 2008 and 2017. During this FOREUMfunded
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.
Two patient representatives, one from the patient user council of Diakonhjemmet hospital and one from the National Association of Rheumatology, are involved in all stages of the project. The aim is to have regular meetings and communication with the patient representatives to include them in the development of protocol writing, choice of outcome measures, final analyses and presentation and dissemination of results. The project group will actively seek to disseminate results from the projects to patients through lay summaries and presentations at patient organization meetings.