Previous research indicates that patients with rheumatoid arthritis (RA) are at increased risk of developing cardiovascular disease (CVD) when compared with the general population. “According to meta-analyses, patients with RA have a 48% increased risk for CVD and a 50% increased risk for mortality due to CVD compared with the general population,” says Dr. Burggraaf. “While the majority of the attention has focused on reducing the inflammation present in RA with effective treatment of the RA disease activity, studies of the traditional cardiovascular disease risk factors in RA are lacking.”

For a study published in BMJ, Benjamin Burggraaf, MD, and colleagues sought to evaluate a treat-to-target approach versus usual care regarding traditional CVD risk factors in patients with RA. Patients with RA younger than 70 without prior CVD or diabetes were randomized 1:1 to a treat-to-target approach or usual care of traditional CVD risk factors, with about 68% completing 5 years of follow-up. The primary outcome was  change in carotid intima media thickness (cIMT) over 5 years, and the secondary outcome was a composite of first occurrence of fatal and non-fatal cardiovascular events. Mean cIMT progression was significantly reduced in the treat-to-target group when compared with the usual care group (0.023 mm vs 0.045 mm). Cardiovascular events occurred in 1.3% of the patients in the treat-to-target group and 4.7% in the usual care group. While no differences in blood pressure or glucose control were observed between the groups, significantly lower LDL-cholesterol levels were achieved in the treat-to-target group.

“We show for the first time that a treat-to-target approach of traditional cardiovascular risk factors reduced the progression of subclinical atherosclerosis in patients with RA compared with usual care,” says Dr. Burggraaf.


Effect of a treat-to-target intervention of cardiovascular risk factors on subclinical and clinical atherosclerosis in rheumatoid arthritis: a randomised clinical trial