Rates for first heart attacks extremely high in RA patients

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Rates for first heart attacks extremely high in RA patients

Rheumawire

Aug 16, 2004

Mann

Malmö, Sweden - New research confirms what many rheumatologists

routinely see in practicerheumatoid-arthritis (RA)-related

cardiovascular disease is a substantial health problem [1]. Dr Carl

Turesson (Malmö University Hospital, Sweden) reports in the August 2004

issue of ls of the Rheumatic Diseases that beginning at about age

60, RA patients have dramatically higher-than-expected rates for

cardiovascular events. This increase is almost entirely due to a high

rate of first acute myocardial infarctions (MIs), not to strokes.

" Heightened awareness of the risk of CVD, as well as adequate prevention

strategies, is of major importance in the management of patients with

RA, " the investigators conclude.

Swedish researchers set out to investigate the incidence of first MI and

stroke in a community-based RA cohort when compared with members of the

general population. The RA cohort consisted of all 1022 patients in a

local RA register in Malmö, Sweden. Turesson says that these patients

were recruited from private- and hospital-based rheumatology practices

and included the majority of patients with RA in this city. The control

subjects were the general population age 16 and older207 846 residents

of Malmö.

The researchers culled information about all first-ever myocardial

infarctions and strokes in Malmö residents between July 1997 and

December 1999 from the Swedish National Hospital Discharge Register and

the national Swedish Causes of Death Register. They then calculated age-

and sex-adjusted standardized morbidity ratios (SMR) for the 2 cohorts.

The researchers did not control for lifestyle factors such as smoking

and obesity.

Of the RA patients, 54 had a first-ever MI or stroke during the study

period, compared with 3862 subjects in the general population. The age-

and sex-adjusted SMR for first CV event was 161 for the RA patients (95%

CI 121-210), and the incidence was higher for both male and female RA

patients.

Most of the CV events in the RA cohort were first MIs, the researchers

report. The SMR for first MI in the RA patients was 176 (95% CI 123 to

244) and 20 RA patients had a stroke, compared with 1840 people in the

general population.

While there was a trend toward increased first stoke among RA patients,

it was not statistically significant. Among the RA patients who had a

stroke, 3 had hemorrhagic strokes and 17 had nonhemorrhagic or

nonspecified strokes.

" RA-associated vascular abnormalities [may] specifically predispose to

coronary artery disease and not to cerebrovascular events, " the

researchers write.

The link between RA and increased risk of CVD is not yet fully

understood, the researchers point out. They note, " Recent reports

indicate that carotid artery intima-media thickness may be increased in

people with RA and that it correlates with markers of systemic

inflammation in patients with RA as well as in subjects without the

disease. "

Calling the new study " important, " Dr Salahuddin Kazi (Dallas VA Medical

Center, TX) tells rheumawire that the most important limitation is that

the available data did not enable the authors to control for differences

in lifestyle factors between the RA cohort and the standard population.

" This would have been important to help separate the contribution of

say, smoking and rheumatoid arthritis, which may be the real driver of

the increased coronary artery disease vs the association with RA

itself, " he says.

However, Kazi says that this factor does not reduce the importance of

the study. " My own experience within the Veterans Hospital and the very

fact that the number of these [cardiovascular] end points in RA are

increased (regardless of the true nature of the association), behooves

us to aggressively manage patients with RA with cardiovascular risk

factors as if they already had coronary artery disease, " Kazi says. " I

would propose that all patients with RA should have aggressive

smoking-cessation intervention, lifestyle modifications including

increased exercise (if possible), rigorous control of hypertension and

diabetes mellitus, and aggressive lowering of cholesterol. "

Source

Turesson C, Jarenros A, and sson L. Increased

incidence of cardiovascular disease in patients with rheumatoid

arthritis: results from a community based study. Ann Rheum Dis 2004;

63:952-955.

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Mayo Clinic in Rochester

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s Hopkins Medicine

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