Page 117 - THE EVOLUTION OF EARLY ARTHRITIS AND CARDIOVASCULAR RISK Samina A. Turk

INTRODUCTION
Ischemic heart diseases and strokes are the most common causes of death, accounting together for 15 million deaths in 2015(1). Different cardiovascular (CV) risk models exist, which estimate the 10-year risk of fatal and non-fatal CV diseases (CVD), and indicate if an antihypertensive and/or statin is necessary to lower the chance of a future CV event(2-5). Rheumatoid arthritis (RA) is associated with an increased risk of CVD, with atherosclerotic diseases being the leading cause of death(6;7). CV risk models were developed for the general population and do not perform well in the RA population(4). Therefore, the European League Against Rheumatism (EULAR) recommends to use a modified risk score for RA patients, by applying a multiplication factor of 1.5 to the CV risk scores(8). In the Dutch Systematic COronary Risk Evaluation (SCORE) a correction for RA patients is already taken into account(2;4;5).
The increased risk in RA patients for CVD has multiple causes. RA and CVD are both multifactorial disorders, with some shared risk factors (smoking, metabolic syndrome),
common susceptibility genes and they might even have a shared etiology(6;9-13).
However, most interesting is the influence of inflammation on CVD. Current evidence
supports an important role of inflammation in the formation of an atherosclerotic plaque(14;15). Previous literature showed that improvement in RA disease activity is 6 associated with an increase in cholesterol levels, and a decrease in TC:HDL ratio; an important CV risk predictor(16). However, all previous studies assessed the change in
lipid profile six months or later after initiation of anti-rheumatic treatment(16-19). It is unclear whether this effect is already present early after initiating treatment and what effect this would have on CV risk and optimal CV risk management. Therefore, different CV risk scores (Dutch SCORE and European Heart SCORE), the traditional risk factors and indication for preventive treatment were determined in early RA patients before and after the first four weeks of anti-rheumatic treatment. Exploratory analysis were performed to determine the effect of inflammation on CV risk score, as well as the relation between inflammation, CV risk scores and the different components of the risk score.
METHODS
Study population
The ‘Early Arthritis Cohort’ at Reade in Amsterdam, the Netherlands, includes patients aged 18 years and older, with no prior treatment with disease-modifying antirheumatic drugs (DMARDs). Patients in this cohort who fulfilled the ACR/EULAR 2010 criteria for RA(20) and started treatment with methotrexate and glucocorticoids, between June 2014 and March 2017, were included in this study. Patients with insulin-dependent diabetes mellitus were excluded. All patients gave written informed consent according to the Declaration of Helsinki and approval was obtained from the local ethics committee (Ethics Committee of the Slotervaart Hospital and Reade, Amsterdam, The Netherlands).
CHANGE IN CARDIOVASCULAR RISK
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