Cardiovascular disease risk factors in newly diagnosed rheumatoid arthritis: A retrospective cohort study

Background and objectives: Patients with rheumatoid arthritis (RA) face an increased risk of cardiovascular disease (CVD) that traditional risk factors alone cannot fully explain. Chronic inflammation may influence lipid profiles and contribute to this risk. This study evaluates predictors of incident CVD in RA and explores how erythrocyte sedimentation rate (ESR) modifies the relationship between lipid levels and CVD outcomes. Design, settings, participants, and measurements: This retrospective cohort study included 1,802 RA patients aged 40-79 years, diagnosed between 2015 and 2022, and free of CVD at diagnosis. We evaluated the association between traditional cardiovascular risk factors-including current smoking, diabetes mellitus, systolic blood pressure, body mass index (BMI), HDL cholesterol, and LDL cholesterol-and RA-specific inflammatory markers, including ESR and C-reactive protein (CRP), with the incidence of CVD. Cox proportional hazards models adjusted for age, sex, race/ethnicity, antihypertensive medications, lipid-lowering medications, and antiplatelet medications. Results: During a median follow-up of 3.5 years, 187 patients (10.4 %) developed CVD. The mean BMI was 32 kg/ m2 (standard deviation [SD] 10), HDL cholesterol was 53 mg/dL (SD 17), and LDL cholesterol was 104 mg/dL (SD 37). The median ESR was 21 mm/hr (interquartile range [IQR] 11-42) and CRP was 6 mg/L (IQR 3-12). Higher LDL cholesterol was inversely associated with CVD risk (HR 0.77 per SD increase, 95 % CI 0.63-0.94), with this association weakening with increasing ESR levels (interaction term HR 0.84, 95 % CI 0.71-0.99). Elevated HDL cholesterol also showed significantly decreased CVD risk (HR 0.82 per SD increase, 95 % CI 0.68-0.97). Smoking and diabetes were associated with increased risks (HR 1.52, 95 % CI 1.07-2.17 and HR 2.08, 95 % CI 1.39-3.10, respectively). Conclusion: This study highlights the complex interplay between lipid levels and inflammation in RA, highlighting the nuances of CVD risk assessment in RA.