More evidence that RA, SLE increase risk of myocardial infarction

[Guest guest]

Jan 9, 2003

More evidence that RA, SLE increase risk of myocardial infarction

Basel, Switzerland - A large, observational, case-control study confirms

that patients with systemic inflammatory diseases such as rheumatoid

arthritis (RA) and systemic lupus erythematosus (SLE) are at increased risk

of myocardial infarction (MI) [1]. And the data, from the UK General

Practice Research Database (GPRD), show that the risk of MI seems to be

particularly pronounced in those sufferers who also have hyperlipidemia.

" These results underline that RA and SLE increase the risk of AMI, " say the

researchers, led by Lorenz M Fischer (University Hospital Basel,

Switzerland).

The findings, published in the January 15, 2004 issue of the American

Journal of Cardiology, come hard on the heels of other research, such as

that from the Nurses Health Study, published last year, showing that women

with RA had a 2-fold higher risk of MI than women without RA. " However, we

also included men in our analysis and studied the association between . . .

SLE and AMI, " Fischer et al note.

They found that the association between diagnosed SLE and the risk of AMI

was even more pronounced than that for RA. Only last month, 2 papers in the

New England Journal of Medicine showed that atherosclerosis develops

extraordinarily early in those with lupus, and the authors suggested that

lupus should now be considered an independent risk factor for

atherosclerosis, in the same way that diabetes is [2,3].

Fischer and colleagues also found a substantially increased risk for

subjects with hyperlipidemia and inflammatory diseases, and they say that

aggressive treatment to prevent ischemic heart disease seems to be

particularly important for subjects with both of these conditions.

" The risk [of MI] does increase quite dramatically when [hyperlipidemia] is

present . . . there's really something going on here. "

Second author G Schlienger (University Hospital Basel, Switzerland)

told rheumawire: " The finding that hypercholesterolemia is an additional

risk factor is quite interesting. The risk does increase quite dramatically

when this is present . . . there's really something going on here. "

More than 40 000 patients included in study

Fischer and colleagues compared 8688 patients from the UK GPRD suffering a

first-time MI with 33 329 matched controls between January 1995 and April

2002. Adjusting for a whole host of risk factors, including body mass index,

smoking status, aspirin use, use of nonsteroidal anti-inflammatory drugs

(NSAIDs), and history of various cardiovascular conditions, the researchers

found that those with RA were 1.5 times more likely to suffer AMI, and if

these patients also had hyperlipidemia, the risk was 7-fold higher.

For those with SLE, the risk of having a first MI was almost 3 times that of

the controls, again rising significantly when sufferers also had

hyperlipidemia. The odds ratio for first MI in men with SLE was also twice

that of women with the disease, but this difference between genders was not

statistically significant, Schlienger said. He added that it was difficult

to know whether this difference between the sexes in lupus patients was a

true effect or not, because of the very small patient numbers involved.

Schlienger told rheumawire that although the team adjusted for the use of

NSAIDs, they did not adjust for the use of methotrexate or any other

rheumatoid arthritis drugs or for any lupus treatments. " There is some

evidence that methotrexate is protective against MI and that any therapy

that tackles the inflammation will reduce the risk of MI, but we didn't look

at this specifically. "

" These results . . . fit well with the concept that systemic inflammation

accelerates atherosclerosis and increases the risk for cardiovascular

disease. "

" These results, from a large, population-based, case-control analysis, using

a well-validated database from the United Kingdom, fit well with the concept

that systemic inflammation accelerates atherosclerosis and increases the

risk for cardiovascular disease, " the researchers note.

" The results of the present study support the statement [by the Nurses

Health Study researchers] that subjects with chronic systemic inflammatory

diseases may profit from aggressive strategies to prevent ischemic heart

disease. This seems to be particularly important for subjects with both

inflammatory diseases and hyperlipidemia, " they conclude.