What are the risk factors for MACE, malignancy in rheumatoid arthritis?

Factors such as male sex, older age, and prior X-ray examination are linked to an increased risk of major adverse cardiovascular events (MACE) and malignancies in patients with rheumatoid arthritis (RA), according to a study from Japan.

Researchers used the Real World Data database of medical institutions in Japan and looked at adults who received a diagnosis of RA, were given a prescription for at least one antirheumatic drug, and had no diagnosis of psoriasis. Patients had no documented myocardial infarction/stroke ≤31 days or malignancy <1 year before index.

A total of 16,012 RA patients were included in the MACE cohort and 14,545 in the malignancy cohort. Most of the patients from the two cohorts were female and at least 65 years of age.

During the study period, 214 MACE occurred in 43,964.7 patient-years for an incidence rate of 0.49 per 100 patient-years. Similarly, 315 malignancies occurred in 40,251.6 patient-years, with an incidence rate of 0.78 per 100 patient-years.

Cox regression models showed that the risk of MACE was positively associated with male sex, older age (≥65 years), hypertension, renal disease, cerebrovascular disease, and prior X-ray examination. Risk factors for malignancy risk included male sex, older age (≥50 years), NSAID use, emphysema, serious infection, malignancy history, and prior X-ray examination. Conversely, glucocorticoid use and fracture diagnosis were associated with reduced malignancy risk.