RESEARCH - Disease activity as a risk factor for myocardial infarction in RA

August 16, 2008

Ann Rheum Dis. Published Online First: 13 August 2008.

doi:10.1136/ard.2008.089862

Rheumatism

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Extended Report

Disease activity as a risk factor for myocardial infarction in

Rheumatoid Arthritis

Beáta J Radovits 1*, Delia A Popa-Diaconu 1, Calin Popa 1, Agnes

Eijsbouts 2, Roland FJM Laan 1, Piet LCM Van Riel 1 and Jaap Fransen 1

1 Radboud University Nijmegen Medical Centre

2 Sint Maartenskliniek Nijmegen

Abstract

Objective: Patients with rheumatoid arthritis (RA) are at greater risk

of developing coronary heart disease (CHD) than the general

population. Systemic inflammation may contribute to this risk.

Therefore, this study investigated whether the level of disease

activity is associated with the risk of developing myocardial

infarction (MI) in RA patients.

Methods: We performed a case-control study within a large prospective

cohort of RA patients. Cases were patients who developed their first

MI after the diagnosis of RA, controls were RA patients without MI.

Cases and controls had similar RA disease duration. Traditional and

disease-specific risk factors for MI were collected and a

time-averaged DAS28 was calculated. The data were analyzed using

conditional logistic regression analysis.

Results MI cases had significantly higher age, were more often male,

with higher BMI and total cholesterol and lower HDL serum levels than

controls. Time-averaged disease activity however was similar for cases

and controls. The raw OR for MI in patients with a " high " (> 4.0)

versus a " low " ( " T 4.0) average DAS28 was 1.2 (95% CI 0.61-2.36). The

OR (95%CI) corrected for age, gender, BMI, baseline HAQ and baseline

HDL was 0.91 (0.39-2.12).

Conclusion: RA patients with MI had more classical risk factors, but

not higher disease activity over time, than control RA patients. Low

levels of inflammation may be sufficient for accelerated atherogenesis

and excess risk of CVD in RA.

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Not an MD

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