Cardiovascular disease incidence among aging patients with rheumatoid arthritis: Results from the Canadian Longitudinal Study on Aging (CLSA)

Background and aims: Rheumatoid arthritis (RA) is associated with a higher risk of cardiovascular disease (CVD). This study examined CVD incidence among middle-aged and older Canadians with and without RA and identified the role of potential risk factors for CVD in this population. Methods and results: Data were obtained from the Canadian Longitudinal Study on Aging (CLSA) using three time points between 2011 and 2021. Incidence rate ratios (IRR) for CVD were calculated to compare CVD incidence among RA and non-RA individuals. Cox proportional hazards regression models identified the potential risk factors associated with CVD incidence. Stratification based on sex, age and education levels were conducted. The analysis included 19,844 participants. RA patients (N = 553) experienced significantly higher CVD incidence, compared to the non-RA individuals (IRR = 1.69, 95% CI: 1.34 – 2.11). Multivariable analysis showed that RA, elevated C-reactive protein (CRP) level, disease-modifying antirheumatic drugs (DMARDs) other than methotrexate, male sex, older age, low physical activity, smoking, dissatisfaction with sleep quality, diabetes, hypertension and mood disorders were significant risk factors for CVD. Stratified analyses revealed stronger associations between RA and CVD among females, individuals <65 years old and those with lower education levels. Conclusions: This large population-based study confirmed the elevated risk of CVD among RA patients and identified high-risk subgroups, including females, younger individuals and those with lower socioeconomic status. This highlights the need for targeted prevention and management strategies in these vulnerable populations. Future research should explore underlying mechanisms and tailored interventions to mitigate the risk.