Ten-year incidence and heart failure dominance of hospitalized cardiovascular events in rheumatoid arthritis: a hospital-based cohort study from Martinique.

Higher risks of cardiovascular mortality and cardiovascular events have been reported in patients with rheumatoid arthritis (RA) compared with the general population. However, data remain scarce in populations of African descent, and the Caribbean region is under-represented in this field. We aimed to assess the burden of hospitalized cardiovascular events (HCE) in Martinique, a French Caribbean overseas territory with a predominantly Afro-Caribbean population. We conducted a retrospective cohort study of patients with RA from Martinique identified through the hospital discharge database. The 10-year cumulative incidence of HCE was estimated using the Fine and Gray competing-risk method, with a sensitivity analysis restricted to the classical 3-point major adverse cardiovascular events (MACE) definition. Among 205 patients with RA, 50.5% had hypertension, 30.0% diabetes mellitus,39.4% had dyslipidemia and 59.5% were overweight or obese. Smoking exposure was uncommon. 10-year cumulative incidence of HCE was 8.3% (95% CI 4.5-12.1) for the overall composite endpoint and 4.0% (95% CI 1.3-6.8) when restricted to 3-point MACE. Acute heart failure (HF) accounted for 47.1% (8/17) of events and was mostly incident, with non-ischemic etiologies. Patients with RA who developed HCE were significantly older at RA diagnosis, more frequently diabetic, and exposed to fewer bDMARDs or tsDMARDs. HCE affected a substantial proportion of patients with RA in Martinique with incidence estimates comparable to other RA cohorts despite a distinct cardiometabolic profile. HF emerged as the leading cardiovascular outcome, supporting the integration of heart failure prevention and early detection into cardiovascular surveillance strategies for RA in this setting.