Abstract Background/Aims Depression is a frequent comorbidity in rheumatoid arthritis (RA), and both conditions have been independently associated with increased cardiovascular risk. Depression may also partially mediate the relationship between RA and adverse cardiovascular outcomes. We therefore examined whether baseline depression was associated with cardiovascular events in an early RA cohort. Methods We included adults with RA enrolled in the National Early Inflammatory Arthritis Audit (NEIAA) between May 2018 and May 2023, linked to Hospital Episode Statistics and Office for National Statistics records. Depression was defined by clinician-reported diagnosis at baseline. The primary outcome was first cardiovascular hospitalisation. Competing risk models, accounting for non-CV mortality, were performed to estimate subdistribution hazard ratios (sHRs) for depression, sequentially adjusted for age, sex, smoking, and baseline comorbidities (diabetes, hypertension and myocardial infarction). Sensitivity analyses incorporated PHQ-4-derived psychological distress and multiple imputation for missing data. Results Among 17,669 RA patients included, 1,292 (7.3%) reported depression at baseline. Patients with depression were younger (median 56 years IQR 47-64) and more often female (79.2%) and current smokers (31%) (Table 1). During a median follow-up of 1.21 years (IQR 0.51-2.35), 1,012 cardiovascular hospitalisation events were identified, including 62 events among patients with depression (1.88 per 100 person-years) and 943 without (2.29 per 100 person-years). After adjustment, depression was not significantly associated with increased cardiovascular risk (age/gender-adjusted sHR 1.13, 95% CI 0.87-1.47; fully adjusted sHR 1.05, 95% CI 0.81-1.37). No interaction by age or sex was observed (p 0.1). Sensitivity analyses using PHQ-4 scores produced consistent results. Conclusion In this early RA cohort, baseline depression was not independently associated with increased cardiovascular hospitalisation risk. This may reflect the benefits of earlier diagnosis, tighter inflammation control, and more proactive cardiovascular prevention in modern RA care. Even so, the relatively short follow-up means that longer-term effects of depression on cardiovascular health cannot be excluded. These findings raise the possibility that effective inflammation control and systematic cardiovascular risk management may mitigate, but not eliminate, the broader health implications of depression. Continued attention to mental health remains essential to support quality of life and long-term cardiovascular health in RA. Disclosure Z. Yang: None. K. Song: None. F. Atzeni: None. M. Russell: Consultancies; MDR has received consultation fees from Pfizer. Honoraria; MDR has received honoraria from AbbVie, Galapagos, Johnson JG has received honoraria from AbbVie, Biovitrum, BMS, Celgene, Chugai, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi and UCB.
Yang et al. (2026) studied this question.