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

Objectives

  • To explore contemporary incidence and prevalence of RA, PsA and AS in Norway
  • To evaluate all-cause and cause-specific mortality in patients with RA, AS and PsA compared to the general population
  • To study prevalence, incidence and outcome of CVDs in IJDs compared to the general population
  • To compare the risk of CVD among users and non-users of biologic disease-modifying antirheumatic drugs in patients with IJD
  • To explore sex differences in CVD event rates in patients with IJD compared to the general population
  • To compare the use of secondary preventive medication in patients with IJD and general population controls after acute coronary syndrome (ACS)
  • To study similar research questions among Finnish IJD patients based on Finnish register data

The results from this project may facilitate the establishment of CVD prevention recommendations/guidelines specifically developed for patients with IJD.

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 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.

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
    Read more
  • 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
    Read more
  • 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
    Read more
  • 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
    Read more
  • 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.
    Read more

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

Patient voice

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.

Project Map