Perspective from Howard Blumstein, MD
Disclosures: The researchers report no relevant financial disclosures.
July 01, 2020
3 min read
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Coronary artery disease plus RA exacerbates risk for adverse CV events, mortality

Perspective from Howard Blumstein, MD
Disclosures: The researchers report no relevant financial disclosures.
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Among patients with coronary artery disease, rheumatoid arthritis was significantly associated with an elevated risk for myocardial infarction, major adverse cardiovascular events and all-cause mortality, according to data.

“Risk stratification and strategies to prevent cardiovascular events in patients with RA — such as treating hypertension, encouraging patients to stop smoking and reinforcing statin therapy — may be especially important, regardless of whether they have a history of coronary artery disease, because their risk for adverse cardiovascular outcomes is significantly greater than for patients who have neither RA nor coronary artery disease (CAD),” Brian Bridal Løgstrup, MD, PhD, of Aarhus University Hospital, in Denmark, told Healio Rheumatology.

RA is significantly associated with a 10-year risk for myocardial infarction, major adverse cardiovascular events and all-cause mortality among those undergoing coronary angiography, regardless of the presence of coronary artery disease, according to data.

“Our study makes a significant contribution to the literature in reporting on the additive risk of RA and CAD,” he added.

To examine the impact of RA on the risk for adverse cardiovascular events among patients with and without coronary artery disease, Løgstrup and colleagues assembled a population-based cohort of individuals in the Western Denmark Heart Registry. According to the researchers, this registry includes information regarding all cardiac procedures performed in Western Denmark since 1999, covering a population of approximately 3.5million people. For their study, the researchers included patients who underwent coronary angiography between 2003 and 2016. These patients were then stratified by the presence of RA and coronary artery disease.

Løgstrup and colleagues included 125,331 patients from the registry, of whom 1,732 had RA. Endpoints included myocardial infarction, major adverse cardiovascular events such as ischemic stroke and cardiac death, and all-cause mortality. The median follow-up was 5.2 years.

Brian Bridal Løgstrup

According to the researchers, compared with patients with neither RA nor coronary artery disease, who had a cumulative myocardial incidence of 2.7%, the 10-year risk for myocardial infarction for those with RA alone was higher, at 3.8% (IRR = 1.63; 95% CI, 1.04-2.54). The 10-year risk for myocardial infarction was also higher among patients with coronary artery disease alone, with a cumulative incidence of 9.9% (IRR = 3.35; 95%CI, 3.1-3.62).

However, the 10-year risk was highest among patients with both RA and coronary artery disease, with a cumulative incidence of 12.2% (IRR = 4.53; 95% CI, 3.66-5.59). Similar links were reported for major adverse cardiovascular events and all-cause mortality.

“Our study makes a significant contribution to the literature in reporting on the additive risk of RA and coronary artery disease,” Løgstrup said. “Among patients with coronary artery disease, RA was associated with an increased risk of acute myocardial infarction, major adverse cardiovascular events, cardiac death and all-cause mortality.”

“These findings indicate that RA may have a potential impact for precipitating cardiovascular events beyond coronary artery disease and, even more importantly, that RA seems to exacerbate the clinical risk of cardiovascular events in the presence of coronary artery disease,” he added. “The results of our study could result in more aggressive risk stratification among patients with RA, by presence or absence of documented coronary artery disease, which may allow for a more personalized treatment strategy.”