Smoking cessation is associated with lower disease activity and predicts cardiovascular risk reduction in rheumatoid arthritis patients

Ida K Roelsgaard, Eirik Ikdahl, Silvia Rollefstad, Grunde Wibetoe, Bente A Esbensen, George D Kitas, Piet van Riel, Sherine Gabriel, Tore K Kvien, Karen Douglas, Solveig Wållberg-Jonsson, Solbritt Rantapää Dahlqvist, George Karpouzas, Patrick H Dessein, Linda Tsang, Hani El-Gabalawy, Carol A Hitchon, Virginia Pascual-Ramos, Irazú Contreras-Yáñez, Petros P SfikakisMiguel A González-Gay, Cynthia S Crowson, Anne Grete Semb

Research output: Contribution to journalArticle

9 Citations (Scopus)


OBJECTIVES: Smoking is a major risk factor for the development of both cardiovascular disease (CVD) and RA and may cause attenuated responses to anti-rheumatic treatments. Our aim was to compare disease activity, CVD risk factors and CVD event rates across smoking status in RA patients.

METHODS: Disease characteristics, CVD risk factors and relevant medications were recorded in RA patients without prior CVD from 10 countries (Norway, UK, Netherlands, USA, Sweden, Greece, South Africa, Spain, Canada and Mexico). Information on CVD events was collected. Adjusted analysis of variance, logistic regression and Cox models were applied to compare RA disease activity (DAS28), CVD risk factors and event rates across categories of smoking status.

RESULTS: Of the 3311 RA patients (1012 former, 887 current and 1412 never smokers), 235 experienced CVD events during a median follow-up of 3.5 years (interquartile range 2.5-6.1). At enrolment, current smokers were more likely to have moderate or high disease activity compared with former and never smokers (P < 0.001 for both). There was a gradient of worsening CVD risk factor profiles (lipoproteins and blood pressure) from never to former to current smokers. Furthermore, former and never smokers had significantly lower CVD event rates compared with current smokers [hazard ratio 0.70 (95% CI 0.51, 0.95), P = 0.02 and 0.48 (0.34, 0.69), P < 0.001, respectively]. The CVD event rates for former and never smokers were comparable.

CONCLUSION: Smoking cessation in patients with RA was associated with lower disease activity and improved lipid profiles and was a predictor of reduced rates of CVD events.

Original languageEnglish
Pages (from-to)1997-2004
Number of pages8
JournalRheumatology (Oxford, England)
Issue number8
Early online date28 Nov 2019
Publication statusPublished - 1 Aug 2020

Bibliographical note

© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology.


  • behaviour
  • epidemiology
  • outcome measures
  • quality of life;
  • rheumatoid arthritis


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