Trihealth Good Samaritan Hospital Cincinnati, United States
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Background/Purpose: Rheumatoid arthritis (RA) is associated with increased cardiovascular risk, but the additional impact of comorbid type 2 diabetes mellitus (T2DM) on cardiovascular outcomes in this population remains incompletely characterized. This study evaluated the cardiovascular burden in patients with both RA and T2DM compared to patients with RA alone. Methods: Using the TriNetX global federated health research network, we conducted a retrospective cohort study of 187,967 patients with RA from 100 healthcare organizations. Patients aged 18-99 years with RA (ICD-10 M06.9) were stratified by T2DM status (ICD-10 E11). After propensity score matching for cardiovascular risk factors and comorbidities, we analyzed 129,630 patients in each cohort. Cardiovascular outcomes were assessed over a 5-year follow-up period. Results: Patients with comorbid RA and T2DM demonstrated significantly higher risk of mortality (HR 1.73, 95% CI 1.69-1.78, p< 0.001), cardiac arrest (HR 2.85, 95% CI 2.61-3.10, p< 0.001), and heart failure (HR 1.93, 95% CI 1.86-1.96, p< 0.001) compared to patients with RA alone. Additionally, the comorbid group showed increased risk of atrial fibrillation (HR 1.97, 95% CI 1.92-2.02, p< 0.001), ventricular arrhythmias (HR 2.18, 95% CI 2.05-2.32, p< 0.001), cerebral infarction (HR 1.67, 95% CI 1.60-1.75, p< 0.001), and acute kidney failure (HR 2.57, 95% CI 2.49-2.66, p< 0.001). Patients with both conditions also required more cardiac device implantations (HR 2.65, 95% CI 2.50-2.80, p< 0.001). Conclusion: Coexisting T2DM in patients with RA substantially increases the risk of major adverse cardiovascular events and mortality. These findings highlight the need for aggressive cardiovascular risk assessment and management strategies in this high-risk population. Interdisciplinary care involving rheumatologists and endocrinologists may be crucial for optimal management of this patient group.
